CYFRA21-1、CA153单项及联检诊断肺癌癌性胸水的临床价值

目的：本文探讨肿瘤标志物CYFRA21-1、CA153单项及两项联检诊断肺癌癌性胸水的临床价值。方法：采用RIA法。结果：本文对51例肺癌癌性胸水及38例结核性胸膜炎良性胸水同时检测CYFRA21-1及CAl53，结果 表明良性组CYFRA21-1有2例假阳性（5．26％）；CA153无假阳性病例。恶性组CYFRA21-1，31例阳性，阳性率60．78％，CA153，29例阳性，阳性率56．86％，良恶性组经统计学处理有显著性差异（P〈0．01）。CYFRA21-1、CA153＋病例与脱落细胞＋符合率均在50％以上，CYFRA21-1＋CA153联检可使单项阳性率提高到92.1％。结论：两项肿瘤标志物均对良恶性胸水的鉴别诊断具有可信的临床价值。由于CA153无假阳性、特异性高于CYFRA21-1，故作为单项使用，建议首选CA153，为减少漏诊，仍应采用CYFRA21-1＋CA153联检为宜。在临床高度怀疑恶性胸水，而脱落细胞检查阴性情况下，采用此方案更有辅助诊断价值。

Clinical Usefulness of Single and Combined Pleural Effusion Fluid Tumor Markers Assay (CYFRA21-1 and CA153) in the Detection of Pumonary Carcinoma

Objective To explore the clinical usefulness of effusion fluid CYFRA21-1 and CA153 determination in the differential diagnosis of malignancy.Methods Pleural effusion fluid contents of CYFRA21-1 and CA153 were measured with RIA in 51 patients with pulmonary carcinoma and 38 patients with tuberculosis.Results There were two CYFRA21-1 false positive cases(5.26%) in the 38 patients with tuberculosis effusion,but no CA153 false positive cases were present.In the 51 patients with malignant effusion,CYFRA21-1 was positive in 31 cases(60.78%) and CA153 was positive in 29 cases(56.86%)(vs those in benign effusion,P<0.001).Malignant cells were demonstrated in the effusion fluid in 25 of the 51 patients(49.01%).Of the 25 patients,CYFRA21-1 was posstive in 17(68.0%) and CA153 was positive in 13(52.2%).Combined determination of CYFRA21-1 with CA153 would yield a positive rate of 92.15%.Conclusion As CA153 possesses higher specificity(no false positiveness),it should be the diagnostic marker of first choice.However,combined CA153 and CYFRA21-1 test should be employed due to its very high sensitivity(92.15%).Combined determination is especially useful in those cases with negative cytological findings in the effusion fluid.