YKL-40和CEA 在恶性胸腔积液诊断中的应用价值

目的：探讨YKL‐40和癌胚抗原（CEA）在恶性胸腔积液（MPE）诊断中的应用价值。方法收集2013年11月至2014年11月住院的良性胸腔积液患者45例、M PE患者52例，ELISA法检测YKL‐40，全自动电化学发光免疫分析法检测CEA。比较两组患者间YKL‐40和CEA水平差异，以及YKL‐40与M PE临床病理的相关性，并用受试者工作特征曲线（ROC曲线）比较2项指标在MPE诊断中的差异。结果 MPE中YKL‐40平均水平为（189．5±147．0）ng／mL ，明显高于良性胸腔积液组，差异有统计学意义（P＜0．05）；YKL‐40升高与肿瘤类型和有无淋巴结转移有关（P＜0．05），而与性别、年龄、肿瘤分化程度无关（P＞0．05）。YKL‐40诊断MPE的灵敏度和特异度分别为80．9％和51．2％，低于CEA的83．1％和74．6％，差异有统计学意义（P＜0．05）。当二者联用时，灵敏度和特异度可达90．6％和88．2％。结论 YKL‐40在M PE诊断中有一定临床应用价值，其升高提示腺癌或进展期癌可能性大，但灵敏度和特异度低于CEA ，二者联合检测可提高诊断准确性。

The diagnostic value of YKL-40 and CEA in malignant pleural effusion

Objective To investigate the diagnostic value of YKL‐40 and CEA in malignant pleural effusion .Methods There were 45 cases of benign pleural effusion and 52 patients with malignant pleural effusion in this study from November 2013 to No‐vember 2014 .Enzyme linked immunosorbent assay(ELISA) and electrochemi lumine scence immunoassay(ECLIA) method were carried out to detect the concentration of YKL‐40 and CEA respectively .The differences of the two groups of patients between YKL‐40 and CEA levels were compared ,and the correlation between YKL‐40 and clinical pathology of malignant pleural effusion were analyzed .In addition ,the receiver‐operating characteristic curve(ROC curve) was used to compare the diagnostic value be‐tween YKL‐40 and CEA .Results The average value of YKL‐40 in malignant pleural effusion was (189 .5 ± 147 .0)ng/mL ,and sig‐nificantly higher than in benign pleural effusion group(P< 0 .05) .The elevated level of YKL‐40 was related to tumor types and lymphatic metastasis(P<0 .05) ,but it had no correlation with the gender ,age and degree of tumor differentiation(P>0 .05) .The diagnostic sensitivity and specificity of YKL‐40 was 80 .9% and 51 .2% ,which was lower than CEA(83 .1% and 74 .6% )(P<0 .05) .However ,the sensitivity and specificity was 90 .6% and 88 .2% when combined the two biomarkers together .Conclusion YKL‐40 have a certain clinical diagnostic value in malignant pleural effusion ,it indicate to adenocarcinoma or advanced cancer when the level of YKL‐40 rised .Since the sensitivity and specificity is lower than traditional biomarker of CEA ,we should combine with the other tumor markers to improve the diagnostic accuracy .