联合测量肿瘤标志物在鉴别良恶性胸腔积液中的诊断价值

Diagnostic value of combination measurement of tumor markers for differentiating malignant and pleural effusion

关键词:  癌胚抗原  糖链抗原19-9  糖链抗原12-5  肿瘤标志物  胸腔积液

Key words:  CEA  CA19-9  CA12-5  tumor markers  pleural effusion

摘要:

［目的］探讨联合测量胸水及血清中癌胚抗原（CEA），糖链抗原19-9（CA19-9）和糖链抗原125（CA125）在鉴别良恶性胸水中的诊断价值。［方法］用酶联免疫吸附测定法测量179例恶性胸腔积液与167例良性胸腔积液患者的血清和胸水中的CEA，CA19-9和CA125含量，分析其最佳诊断界值，独自及联合诊断的敏感性、特异性和准确率。［结果］以血清CEA≥3.90 ng/mL为界值，其诊断恶性胸腔积液的敏感性、特异性及准确率分别为59.78%、64.07%和62.85%。以胸水CEA≥2.55 ng/mL为界值，其诊断恶性胸腔积液的敏感性、特异性及准确率分别为65.36%、72.45%和68.79%。以胸水CA19-9≥5.75 ng/mL为界值，其诊断恶性胸腔积液的敏感性、特异性及准确率分别为51.95%、74.25%和62.72%。准确率最高的联合诊断方案为血清CEA+胸水CEA，准确率为70.34%。特异度最高的联合诊断为血清CEA+胸水CEA+胸水CA19-9，特异度为89.22%，与血清CEA+胸水CEA，血清CEA+胸水CA19-9及胸水CEA+胸水CA19-9比较，差异有显著性意义（P<0.05）。［结论］CEA和CA19-9在鉴别良恶性胸腔积液中具有重要的临床价值，而联合测量则可提高诊断准确率及特异度。

Abstract:

［Objective］To study the diagnostic value of determining carcinoembryonic antigen (CEA),carbohydrate antigen 19-9 (CA19-9) and carbohydrate 12-5 (CA12-5) in the serum and pleural effusion in the differential diagnosis of benign and malignant pleural effusions.［Methods］The levels of tumor markers of CEA,CA19-9 and CA12-5 in serum and pleural effusion were measured in 179 patients with malignant pleural effusion and 167 patients with benign pleural effusion by ELISA method.The best diagnostic cut-off and the sensitivity,specificity and accuracy of them were analyzed.［Results］ If the cut-off of serum CEA was ≥ 3.90 ng/mL,the sensitivity,specificity and accuracy of diagnosing malignant pleural effusion were 59.78%,64.07% and 62.85% respectively.If the cut-off of pleural effusion CEA was ≥ 2.25 ng/mL, the sensitivity, specificity and accuracy of diagnosing malignant pleural effusion were 65.36%, 72.45% and 68.75%respectively.If the cut-off of pleural effusion pleural effusion CA19-9 was ≥ 5.75 ng/mL,the sensitivity,specificity and accuracy of diagnosing malignant pleural effusion were 51.95%,74.25% and 62.72% respectively.The highest accuracy of combination measurement of tumor markers for differentiating malignant from benign effusions was serum CEA+pleural effusion CEA with accuracy of 70.34%.The highest specificity of combination measurement of tumor markers for differentiating malignant from benign effusions was serum CEA+pleural effusion CEA+pleural effusion CA19-9.［Conclusion］Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-1 (CA19-9) have important clinical value in differentiating malignant and benign pleural effusions,but the combination measurement of the tumor markers can improve accuracy and specificity.