胸水细胞端粒酶活性检测对良恶性胸腔积液的鉴别诊断价值

目的：探讨胸水细胞端粒酶活性对良、恶性胸腔积液的鉴别诊断价值。方法：用改良的PCR-ELISA法检测37例恶性、32例良性胸水细胞端粒酶活性，并与胸水细胞学、癌胚抗原（CEA）诊断结果进行比较。结果：37例恶性胸腔积液中有26例端粒酶活性阳性（26/37），阳性率为70.27%，高于良性胸腔积液中端粒酶海性表达（2/32，P＜0.01)；端粒酶活性检测诊断恶性胸水敏感性为70.27%，特异性为93.75%，与胸水细胞学诊断符合率为54.05%；其敏感性高于胸水CEA诊断结果（敏感性为51.35%)。结论：胸水细胞端粒酶活性检测作为细胞学检查的辅助手段能提高恶性胸水的诊断率，有助于良、恶性胸腔积液的鉴别诊断。

Differential diagnostic value of telomerase activity in malignant and benign pleural effusions

Objective To study the diagnostic value of pleural fluid telomerase activity in distinguishing a malignant from a benign pleural effusion. Methods Using a PCR-based assay, telomerase activity was examined in the pleural fluid cells obstained from 69 patients with pleural effusions (37 malignant, 32 benign). Results were compared with cytologic evaluation and carcinoembryonic antigen (CEA). Results Of the 37 malignant specimens,26(70.27%)contained detectable telomerase activity. The positive rate in malignant pleural effusions was significantly higher than that in benign origin (2/32). Detection of telomerase in effusions was more sensitive than CEA level evaluation for the identification of pleural malignancy (telomerase assay: sensitivity=70.27%, specificity=93.75%; CEA: sensitivity=51.35%, specificity=96.87%). The consistant rate of telomerase with cytology was 54.05%. Conclusion The detection of telomerase activity may be a useful adjunct to cytopathologic methods in the diagnosis of malignant pleural effusions. It may be useful in differential diagnosis of benign and malignant pleural effusions.