脱落细胞学、DNA异倍体和肿瘤标志物检查联合诊断恶性胸腹水的价值探讨

目的：评价脱落细胞学、DNA异倍体、肿瘤标志物检查联合诊断恶性胸腹水的应用价值。方法：贝克曼公司RS-6500流式细胞分析仪,观察DNA异倍体,以DNA异倍体≥10%作为阳性标准;涂片染色,镜下观察细胞形态特征;肿瘤标志物检查使用Combas 6000电化学发光仪测定。结果：39例恶性肿瘤,DNA异倍体分析有21例阳性,阳性率53.9%,70例良性肿瘤仅1例阳性,阳性率1.4%;细胞学检查,39例恶性胸腹水以找到癌细胞为阳性,阳性16例,阳性率41.0%,70例良性胸腹水中,未找到癌细胞;肿瘤标志物（SF、CEA、NSE、CA-125）检查,恶性阳性率为74.4%,61.5%,64.4%,72.0%,良性阳性率为15.8%,21.4%,12.5%,5.6%,差异有统计学意义（P〈0.01）,4项联合检测,以任意一项阳性指标作为阳性判断,可将敏感度提高到92.3%。细胞学、DNA异倍体与肿瘤标志物联合检测,其联合灵敏度为87.0%,联合特异度为77.7%,灵敏度明显提高。结论：脱落细胞学、DNA异倍体、肿瘤标志物联合检测,可大大提高恶性胸腹水的诊断阳性率。

Application value of combined detection of exfoliative cytology,DNA heteroploid analysis and serum tumor marker in malignant pleural/ascitic fluid

Objective：To evaluate the application value of combined detection of exfoliative cytology,DNA heteroploid analysis and serum tumor marker in malignant pleural/ascitic fluid.Method：DNA heteroploid was detected with Beckman Coulter RS6500 flow cytometer,with positive standard as DNA heteroploid≥10%.Morphological characteristics of cells were examined under the microscope.Tumor markers were analyzed with Combas 6000 electrochemiluminescence.Result：In the 39 cases of malignant tumor,21 cases had positive DNA heteroploid（53.9%）,while 1 case positive in 70 cases benign tumors（1.4%）.16 cases had positive exfoliative cytology（41.0%）,no positive in 70 cases patients with benign pleural/ascitic fluid.The positive rates of tumor markers（SF,CEA,NSE,CA-125） were 74.4%,61.5%,64.4% and 72.0% in malignant group,while the positive rate of benign were 15.8%,21.4%,12.5% and 5.6%,respectively.There was a significant difference in tumor markers（P〈0.01）.The sensitivity of combined detection of four tumor markers increased to 92.3%,with the positive standard as any one indicator positive.The sensitivity and specificity of combined detection of exfoliative cytology,DNA heteroploid and tumor marker were 87.0% and 77.7%,respectively.Conclusion：Combined detection of exfoliative cytology,DNA heteroploid and tumor marker could greatly improve the diagnosis rate of malignant pleural/ascitic fluid.