多种肿瘤标志物检测对胸腔积液鉴别诊断的价值

目的 探讨小细胞肺癌（SCLC）、肺鳞癌和肺腺癌患者胃泌素前体释放肽片段31-98（Pro-CLIP）、细胞角蛋白-19（CYFRA21—1）和癌胚抗原（CEA）单项及联合检测对肺癌所致恶性胸腔积液鉴别诊断与组织学分型的临床价值。方法 将103例肺癌所致恶性胸腔积液患者分为SCLC组33例、肺腺癌组37例和肺鳞癌组33例，并以良性胸腔积液组37例及正常对照组35例加以对照。对其血清和胸腔积液ProGRP、CYFRA21-1、CEA进行单项及联合检测，并进行比较。结果 不同肺癌组血清及胸腔积液中ProGRP、CY-FRA21-1、CEA水平均明显高于良性胸腔积液组和正常对照组（P〈0．01）；胸腔积液ProGRP单项检测诊断SCLC所致恶性胸腔积液的Youden指数和诊断准确性最高；诊断肺腺癌和肺鳞癌所致恶性胸腔积液的Yon-den指数及诊断准确性均以胸腔积液CEA、CYFRA21—1联合检测（按平行试验）最高。结论 胸腔积液Pro-GRP是SCLC所致恶性胸腔积液的首选肿瘤标志物；胸腔积液CEA与CYFRA21-1联合检测（按平行试验）为肺腺癌和肺鳞癌所致恶性胸腔积液较好的辅助诊断指标。

Tumor markers in differential diagnosis of the hydrothorax

Objective To study the clinical value of the detection of lung ProGRP,CYFRA21-1 and CEA of the small cell lung cancer (SCLC),the adenocarcinoma of lung and the squamous cell cancer in the differential diagnosis and the histological typing of malignant hydrothorax caused by lung cancer.Methods 103 cases with malignant hydrothorax caused by lung cancer were divided into SCLC group (n=33),adenocarcinoma group(n=37) and squamous cell cancer group (n=33).The benign hydrothorax group (n=37) and the healthy control group(n=35) were taken as control.The value of the hydrothorax ProGRP,CYFRA21-1 and CEA were detected.Results The hydrothorax ProGRP,CYFRA21-1 and CEA in all malignant hydrothorax groups were significantly higher than those in the benign group and healthy controls (P<0.01).Yonden index and accuracy rate of hydrothorax Pro-GRP were the highest in the diagnosis of malignant hydrothorax caused by SCLC.Yonden index and accuracy rate of combined detection of CEA and CYFRA21-1 were the highest in the diagnosis of the malignant hydrothorax caused by the adenocarcinoma of lung and of the malignant hydrothorax caused by adenocarcinoma and squamous cell cancer of lung (on parallel test).Conclusion Hydrothorax ProGRP is the priority tumor marker in the malignant hydrothorax caused by SCLC.The combined detection of CYFRA21-1 and CEA is the better auxiliary diagnosis index for malignant hydrothorax caused adenocarcinoma and squamous cell cancer .