人表皮生长因子受体-2、癌胚抗原、腺苷脱氨酶对鉴别肺癌相关性恶性胸腔积液和结核性胸腔积液的诊断价值

目的探讨胸腔积液中人表皮生长因子受体-2(human epidermal growth factor receptor 2,HER-2)、癌胚抗原(carcinoembryonic antigen,CEA)和腺苷脱氨酶(adenosine deaminase,ADA)三者及三者联合检测对鉴别和结核性胸腔积液的诊断价值。方法选择20例肺癌相关性恶性胸腔积液(malignant pleural effusion,MPE)患者,20例结核性胸膜炎(tuberculous pleurisy,TBP)患者,均诊断明确,分别采用酶联免疫吸附法、化学发光法和酶比色分析法检测两组病例胸液和血清HER-2、CEA和ADA水平。用免疫组织化学方法(SP法)检测胸液沉渣细胞HER-2蛋白。结果①MPE组胸液HER-2水平为(6.18±2.35)ng/mL,显著高于TBP组(3.06±1.18)ng/mL(P0.01),MPE组血清HER-2水平(3.89±1.98)ng/mL也显著高于TBP组(2.31±0.65)ng/mL(P0.05);②TBP组胸液ADA水平(40.70±20.60)U/L显著高于MPE组(13.40±3.18)U/L(P0.01);③MPE组胸液CEA水平为(66.50±43.60)ng/mL,显著高于TBP组(7.91±4.20)ng/mL(P0.01);④检测胸液中HER-2、ADA、CEA水平诊断恶性胸液的灵敏度、特异度、准确度分别为80.0%、95.0%、87.5%;70.0%、90.0%、80.0%;70.0%、100.0%、85.0%。联合检测HER-2、ADA、CEA三者水平诊断恶性胸液的灵敏度、特异度、准确度分别为90.0%、95.0%、92.5%;⑤MPE胸液沉渣细胞免疫组织化学方法(SP法)检测HER-2阳性率达85.0%。结论①单项检测胸液HER-2、CEA、ADA水平对鉴别肺癌相关性MPE和TBP有临床诊断价值;②胸腔积液沉渣细胞免疫组化法HER-2阳性表达率高,且具有较高特异性,有助于肺癌相关性的诊断;③联合检测胸液中HER-2、ADA、CEA水平对鉴别肺癌相关性MPE和TBP具有更理想的临床诊断价值。

Diagnostic values of human epidermal-growth-actor receptor-2, carcinoembryonic antigen and adenosine deaminase in differentiating between malignant pleural effusion-associated lung cancer and tuberculosis pleural effusion

Objective To explore the validity of human epidermal-growth-actor receptor 2(HER-2) and carcinoembryonic antigen(CEA) and adenosine deaminase(ADA) in differentiationg between malignant pleural effusion-associated lung cancer(MPE) and tuberculous pleurisy(TBP).Methods The pleural effusion and serum HER-2 were measured by enzyme linked immunosorbent assay.The pleural effusion CEA was measured by chemilumnoescence immunoassay.The pleural effusion ADA was measured by enzyme-colorimetric analysis antigenic.The ...