良恶性胸腔积液的临床特征及预测因素分析

目的:对比分析良恶性胸腔积液的临床特征，筛选恶性胸腔积液可能的预测因素。方法:收集良性胸腔积液患者30人和恶性胸腔积液患者32人的临床资料，分析胸腔积液及血液学相关指标（胸腔积液物理性状、胸腔积液和血液学生化、肿瘤标志物）。结果:恶性胸腔积液患者的年龄明显高于良性胸腔积液患者，但二者在性别分布上无差异。恶性胸腔积液的乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）、γ-干扰素（γ-IFN）显著低于良性胸腔积液，而癌胚抗原（CEA）、糖类抗原（CA19-9）、神经特异性烯醇化酶（NSE）显著高于良性胸腔积液（P均<0.05）。两组患者血液LDH、ADA、CEA、CA19-9的差异也具有统计学意义。条件Logistic回归分析发现CEA>10ng/ml、血性胸腔积液、ADA<15U/ml、CA19-9>20U/ml为恶性胸腔积液的预测因素。结论:非肿瘤标志物（如胸水颜色、ADA值）也有助于胸腔积液性质的判断。恶性胸腔积液的预测作用由大到小依次为CEA、血性胸腔积液、ADA、CA19-9。

Clinical characteristics and predictors of malignant pleural effusion and non - malignant pleural effusion

Objective:To compare the clinical characteristics between malignant pleural effusion (MPE) and non-malignant pleural effusion (NMPE) and the predictive factors of MPE. Methods:A total of 32 MPE patients and 30 NMPE patients were enrolled in this study.The parameters (physical characteristics，biochemical index and tumor markers) of pleural effusion and plasma were analyzed. Results:The MPE patients were older than NMPE patients.There were remarkably lower LDH，ADA and γ-IFN in MPE than those in NMPE.The MPE patients had a significantly higher CEA,CA19-9,NSE in both pleural effusion and plasma than NMPE patients.CEA>10ng/ml，bloody pleural effusion，ADA<15U/ml and CA19-9>20U/ml were the predictive factors for MPE.Conclusion:The non-tumor markers such as ADA are of value to identify the nature of pleural effusion.The predictive power for MPE are CEA，bloody pleural effusion，ADA and CA19-9 in sequence.