应用ROC曲线评价肿瘤标志物对恶性胸腔积液的诊断价值

目的：探讨癌胚抗原（CEA）、细胞角蛋白（CYRFA21—1）、神经元烯醇化酶（NSE）单独和联合检测在良、恶性胸腔积液中的鉴别诊断价值。方法：应用受试者工作曲线（ROC）对恶性31例及良性30例胸水的CEA、CYRFA21—1、NSE进行分析。结果：恶性胸水CEA、CYRFA21—1和NSE浓度较良性明显增高（P〈0．05）；CEA、NSE、CYRFA21—1单独检测AUC分别为0．831、0．747、0．900，灵敏度分别为67．7％、80．6％、74．2％，特异度分别为96．7％、73．3％、86．7％；NSE联合CEA、NSE联合CYRFA21—1、CEA联合CYRFA21—1检测的AUC分别为0．887、0．916、0．978，灵敏度分别为64．5％、74．2％、93．5％，特异度分别为100．0％、96．7％、90．0％；三项联合检测的AUC为0．985，灵敏度为96．8％，特异度为66．7％。结论：检测胸水中CEA、CYRFA21—1和NSE对良、恶性胸水鉴别均有诊断意义。三项联合检测对恶性胸水诊断准确性高于二项联合检测及单独检测。

An evaluation on diagnostic value of CEA,CYRFA21 -1, NSE in the malignant pleural ef- fusion with ROC curves

Objeetlve：To study the value of separated and combined detection of carcino - embryonic antigen （CEA） ,eytokeratin（ CYRFA21 - 1 ） ,neuron specific enolase（NSE） in benign and malignant pleural effusion. Meth- ods：The clinical findings of 61 patients with pleural effusion（ malignant 31 and benign 30） were retrospectively ana- lyzed by receiver operating characteristics curves（ROC）. Results： The concentration of CEA, CYRFA21 -1 and NSE in malignant pleural effusion was significantly higher than that of benign （ P 〈 0.05 ）. The AUC of CEA, NSE and CYRFA21 - 1 separately detected was 0. 831,0.747,0. 900 respectively. The sensitivity respectively was 67.7%, 80.6% and 74.2%. The specificity respectively was 96.7% ,73.3% and 86.7%. The AUC of combined detection of NSE ＋ CEA,NSE ＋ CYFRA21 - 1, CEA ＋ CYFRA21 - 1 was 0. 887,0. 916,0. 978 respectively. And the sensitivity was 64.5% ,74.2% and 93.5% respectively. The specificity was improved 100.0% ,96.7% and 90.0%. Conse- quently the AUC of combined detection, sensitivity and specificity respectively was 0. 985 ,96. 8% and 66.7%. Con- clusion：Either separated or combined detection of CEA, CYFRA21 - 1, NSE has diagnostic significance to identify the benign and malignant pleural effusion. The combined three assay was more accurate than that of single or two detec- tions.