多项肿瘤标志物测定对良恶性胸腔积液鉴别诊断的价值

目的　探讨单项及联合检测血清、胸腔积液多项肿瘤标志物对良、恶性胸腔积液鉴别诊断的价值。方法　对 67例胸腔积液患者采用全自动化学发光免疫分析技术同步测定血清、胸腔积液癌胚抗原 (CEA)、糖链抗原 1 9- 9(CA1 9- 9)、糖链抗原 1 53(CA1 53)、糖链抗原 1 2 5(CA1 2 5)和糖链抗原 50 (CA50 )、铁蛋白 (Fre)和甲胎蛋白 (AFP)水平。根据最终诊断结果 ,将 67例患者分成二组 :①恶性胸腔积液组 31例 ;②良性胸腔积液组 36例。结果　血清、胸腔积液CEA、CA1 9- 9、CA1 53、CA1 2 5和CA50水平 ,恶性组均高于良性组 ,差异有高度显著性 (P <0 .0 1 ) ;在恶性组中其胸腔积液值均显著高于血清值 (P <0 .0 1 ) ;胸腔积液Fre水平 ,恶性组显著高于良性组 (P <0 .0 1 ) ,恶性组中胸腔积液值显著高于血清值 ,差异有高度显著性 (P <0 .0 1 ) ,但血清Fre水平在良、恶性病变组间比较差异无显著性 (P >0 .0 5) ;血清、胸腔积液AFP值良性组和恶性组间比较差异均无显著性 (P >0 .0 5)。胸腔积液肿瘤标志物单项检测诊断恶性胸腔积液的敏感度由高到低依次为CEA、CA1 53、CA1 2 5、CA1 9- 9、CA50、Fre和AFP ;特异度由高到低依次为CA1 53、CA1 9- 9、CA1 2 5、CEA、CA50、Fre和AFP ;Youden指数由高到低依次为CA1 53、CA1 2

THE VSLUE OF MANY KINDS OF TUMOUR MARKERS'''' DETECTION IN THE DIFFERENTIAL DIAGNOSIS OF THE BENIG AND MALIGNANT PLEURAL EFDUSION

Objective To study the value of detecting the rumour markers in serum and hydrothorax solely and associately in the differential diagnosis of the benign and malignant pleural effusion. Methods with full-antomatic chemiluminescence immunoanology,the serum and hydrothorax level of carcinoem bryonicantigen(CEA),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 153(CA153),carbohydrate antigen125(CA125),carbohydrate antigen 50(CA50),ferritin(Fre)and alpha fetoprotein(FP)were detected rynchronously on 67 patients with piural effusion.Based on the last diagnosis 67 cases were divided into two groups:(1)Malignant plural effusion group:31 cases:(2)benign plural effusion group:36 cases. Results the serum and hydrothorax levels of CEA,CA19-9,CA153,CA125 and CA50 in malignanat group were all significantly higher than the benign one(P<0.01),and in the malignant group,the hydrothorax levels were all significantly higher than the serum levers(P<0.01).The hydrothorax Fre level in malignant group was significantly higher than the benign one(P< 0.01),but no significant different of the serum Fre level was observed in the two groups(P>0.05).There were no sigenificant differences of the serum and hydrothorax AFP levels in the two groups(P>0.05).The seqensce of the tumour makers in hydrothorax detected solely from high to low was CEA,CA153,CA125,CA19-9.CA50 Fre and AFPaccording to the sensitivity in malignant pleural effusion;CA153,CA19-9,CA125,CEA,CA50,Fre and AFP according to the specificity;CA153,CA125,CA19-9,CEA,CA50,Fre and AFP according to the Yonden Index.The sensitivity and Yonden Index could be significanty improved if two or three items of the hydrothorax CEA,CA19-9,CA153 and CA125 were detected associately by paralled test. Conclusion Detecting solely the hydrothorax CEA,CA19-9,CA153,CA125,CA50 and Fre levels is useful to the differential diagnosis,especially when two or three of the hydrothorax CEA,CA19-9,CA153 and CA125 aredected associately,while the serum and hydrothorax AFPlevels have no value.