胸腔积液端粒酶和癌胚抗原测定对良恶性胸腔积液诊断价值对比研究

目的 研究胸腔积液端粒酶活性在良恶性胸腔积液中的鉴别诊断价值，并与癌胚抗原（CEA）进行比较。方法 用聚合酶链反应－酶联免疫吸附分析法（PCR－ELISA）检测胸腔积液端粒酶活性，用酶免疫分析法（EIA）检测胸腔积液CEA水平。根据最终诊断结果，65例患者分成2组：（1）非恶性胸腔积液组：35例，（2）恶性胸腔积液组：30例。并将端粒酶活性检测结果与胸腔积液CEA测定结果进行比较。结果 非恶性胸腔积液中端粒酶阳性2例（5．7％），恶性胸腔积液中阳性27例（90％），端粒酶活性测定诊断恶性胸腔积液的灵敏度为0．90，特异度0．94，阳性预测值0．93，阴性预测值0．92，正确率0．92。CEA诊断灵敏度为0．60，特异度0．89，阳性预测值0．82。阴性预测值0．72，正确 率0．75。结论 胸腔积液端粒酶活性鉴别良恶性胸腔积液的诊断效能明显优于CEA测定，可作为一种诊断恶性胸腔积液的辅助手段。

Comparison of the diagnostic value of telomerase activity with CEA level in benign and malignant pleural effusions

OBJECTIVE: To study the diagnostic value of telomerase activity in differentiating malignant from nonmalignant pleural effusions. METHOD: Sixty-five specimens of pleural effusion were examined for telomerase activity and CEA level by PCR-ELISA and EIA, respectively. According to the final diagnosis achieved, the patients were classified into two groups: group I, 35 nonmalignant pleural effusions, group II, 30 malignant pleural effusions diagnosed by either fluid cytology or pleural biopsy. The results of telomerase activity were compared with CEA levels. RESULTS: Two of thirty-five (5.7%) samples of pleural effusions in group I were found to possess weak telomerase activity and 27 of 30 (90%) samples in group II showed positive enzymatic activity. The diagnostic sensitivity is 0.90, specificity is 0.94, and the positive and negative predictive value are 0.93 and 0.92, respectively. The overall accuracy is 0.92. The diagnostic efficiency of CEA as following: sensitivity 0.60, specificity 0.89, positive and negative predictive value are 0.82 and 0.72, respectively, accuracy 0.75. CONCLUSION: The results indicate that the detection of telomerase activity in pleural effusions is more sensitive, more accurate than CEA in differentiating benign from malignant effusions and can be used as an adjunctive measure in the diagnosis of malignant pleural effusions.