胸膜厚度、腺苷脱氨酶、胸腔积液癌胚抗原/血清癌胚抗原比值对恶性与结核性胸腔积液的鉴别诊断价值

目的评价胸膜厚度、腺苷脱氨酶（ADA）、胸腔积液癌胚抗原/血清癌胚抗原（胸腔积液CEA/血清CEA）比值在恶性与结核性胸腔积液的鉴别诊断中的价值。方法选择经胸腔镜病理组织检查确诊胸腔积液患者91例,按病理结果分为2组,结核性胸膜炎组（结核性组）43例和恶性胸腔积液组（恶性组）48例。对2组患者胸腔积液CEA/血清CEA比值、ADA和CT影像学上表现的胸膜厚度、胸腔积液密度变化进行比较。结果恶性组胸腔积液CEA/血清CEA比值高于结核性组6.72±6.9 vs 0.82±0.43（t=-3.832,P=0.001）,ADA水平低于结核性组（21.9±6.5）vs（50.3±31.9）U/L（t=4.474,P=0.000）];恶性组胸膜厚度〉10.0 mm且以弥漫型为主,结核性组胸膜厚度6.0 mm左右且以局限性为主;胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测的灵敏度、特异度、灵敏度/1-特异性（AUC）分别为90.0%、96.0%、0.869,均高于单检和2项联检,且3项联检的特异度与胸腔积液CEA/血清CEA＋ADA、胸膜厚度＋胸腔积液CEA/血清CEA联检的特异度比较差异均有统计学意义（均P〈0.05）。结论胸膜厚度、ADA、胸腔积液CEA/血清CEA3项联合检测对鉴别恶性与结核性胸腔积液有较高的临床价值。

The Diagnostic Value of Pleura Thickness,ADA and the Ratios of the CEA in the Pleural Fluid and the Blood-serum in the Differentiating Malignan Pleural Effusion to Tuberculous Pleural Effusion

Ojective To evaluate the diagnostic value of pleural thickness,ADA and the ratio of evaluation of CEA in pleural fluid over that in serum.Methods To collect the levels of ADA,the ratios of the CEA in the pleural fluid and the blood-serum,the thicknesses of PLE and the dens of pleural fluid from the 43 patients with tuberculous pleurisy and the 48 patients with malignant pleural effusion were examined.All the cases were definited by thoracoscope.Results The ratio of CEA（6.72±6.9） in the pleural fluid and serum from the patients with malignant pleural effusion were higher than those（0.82±0.43）from the patients with tuberculous pleurisy（t=-3.832,P=0.001）,but the level of ADA（21.9±6.5）U/L in the pleural fluid from the patients with malignant pleural effusion was opposite to those（50.3±31.9）U/L from the patients with tuberculous pleurisy（t=4.474,P=0.000）.The pleura thickness（〉10.0 mm） of malignant pleural effusion was the suffusion,but the pleura thickness（about 6.00 mm） of tuberculous pleurisy was local.The sensitivity（90.0%）,the specificity（96.0%）,AUC（0.869）of the three union-detections were higher than those of mon-detection and union-detections,The sepecificity AUC of the three union-detections were obviously different than those of union-detections of the ratios of the CEA＋ADA and the pleura thickness＋the ratios of the CEA（P〈0.05）.Conclusion The clinic value of the three union-detections should be higher in the differentiating malignant pleural effusion to tuberculous pleural effusion.