CA125在鉴别结核性和癌性胸腔积液中的价值分析

目的探讨血清和胸水中CA125在结核性和癌性胸水的鉴别诊断意义。方法回顾性分析90例结核性胸水患者(结核组)和68例癌性胸水患者(肺癌组)的血清和胸水CA125测定值及二者比值,应用受试者工作曲线(ROC曲线)确定胸水和血清CA125比值对两组鉴别的临界值。结果肺癌组胸水CA125测定值和胸水血清CA125比值分别为(796.95±394.37)U/ml和13.69±5.34,明显高于结核组(281.33±272.13)U/ml和5.83±6.67,差异均有统计学意义(t分别为9.42和7.95,均P﹤0.01),但两组血清CA125测定值差异无统计学意义(t=1.69,P=0.09)。p-CA125/s-CA125﹥10在两组中的比率差异有统计学意义(P=0.00),应用ROC曲线确定的p-CA125/s-CA125比值临界值为10,对癌性胸水的敏感度为82.4%,特异度为75.6%。结论血清和胸水中CA125对于结核性和癌性胸水的鉴别意义不大,但是用胸水和血清CA125比值来鉴别结核性和癌性胸水有一定价值。

Analysis on the diagnostic value of CA125 in tubercular and malignant pleural effusion

OBJECTIVE To investigate the clinical value of pleural fluid carbohydrate antigen 125(CA125)in differentiating tuberculous pleural effusions(TPE)from malignant effusions.METHODS The serum and Pleural CA125 of 158 cases pleural fluid were retrospectively analyzed.TPE were confirmed in 90 cases and malignant effusion in 68 cases.The optimal cutoff of the pleural fluid/serum CA125 ratio was determined by using the ROC curve.RESULTS The mean pleural CA125 was significantly(t = 9.42,P﹤0.01)higher in malignancy(796.95 ± 394.37)u/ml as compared to PTE(281.33 ± 272.13)u/ml,so was the pleural fluid/serum CA125 ratio(13.69 ± 5.34 vs 5.83 ± 6.67,t = 7.95,P﹤0.01),but there was no statistically significant difference between malignant and tuberculous effusion in serum CA125(t = 1.96,P = 0.09).The ratio of p-CA125/s-CA125﹥10 has statistically significant difference in the two groups.The cutoff value of the pleural fluid/serum CA125 ratio for malignant effusion was 10,with a sensitivity of 82.4% and a specificity of 75.6%,the positive predictive was 75.6%,and the negative predictive was 85.5%.CONCLUSION The pleural fluid/serum CA125 ratio has a role in determine the differentiation between tuberculosis and malignant pleural effusions.