| 胸腔积液与血清中的癌胚抗原及其比值对结核性与肺癌性胸腔积液的诊断价值 |
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| 引用本文： | 李锐成,郜赵伟,董轲,王会平,张惠中. 胸腔积液与血清中的癌胚抗原及其比值对结核性与肺癌性胸腔积液的诊断价值[J]. 南方医科大学学报, 2019, 39(2): 175. DOI: 10.12122/j.issn.1673-4254.2019.02.08 |
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| 作者姓名： | 李锐成 郜赵伟 董轲 王会平 张惠中 |
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| 作者单位： | 空军军医大学第二附属医院检验科,陕西 西安,710038;空军军医大学第二附属医院检验科,陕西 西安,710038;空军军医大学第二附属医院检验科,陕西 西安,710038;空军军医大学第二附属医院检验科,陕西 西安,710038;空军军医大学第二附属医院检验科,陕西 西安,710038 |
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| 摘 要： | 目的探讨联合检测胸腔积液癌胚抗原（PCEA）和血清癌胚抗原（SCEA）以及二者比值（PCEA/SCEA，P/S）在鉴别结核性与肺癌性胸腔积液中的临床诊断价值。方法选取并收集我院2016年4月~2018年3月收治的临床确诊的82例结核性胸腔积液液患者（对照组）和120例肺癌性胸腔积患者（试验组）的胸腔积液和血清进行CEA水平检测，计算出P/S值，再将试验组按照不同病理类型分成鳞癌、腺癌和小细胞癌3个亚组进行组间和组内比较，以测得各组间检测指标的水平差异。创建受试者工作特征曲线（ROC曲线）进行分析以确定诊断肺癌性胸腔积液的最佳临界值，以其为诊断标准，计算出单项检测以及联合检测的诊断性能。结果肺癌组和3 个亚组的PCEA、SCEA以及P/S 水平均高于结核组（P<0.05）；3 项指标的ROC曲线下面积分别为0.925、0.866 和0.796，以PCEA为最高，其灵敏度、特异度、准确率、最佳临界值分别为：83.33%、96.34%、88.61%、3.26 ng/mL；SCEA诊断性能最低，但具有取材简便、无创伤的优点；P/S诊断性能高于SCEA、低于PCEA，但与SCEA联合诊断后可大大提高诊断性能，减少误诊和漏诊；并联试验中的三者联合检测的敏感度均高于单项和两两联合检测（P<0.05），特异度无统计学差异;三者联合诊断肺癌性胸腔积液的曲线下面积为0.941，均高于单项和两两联合检测。结论在肯定PCEA诊断优势的同时，也要考虑到SCEA和P/S的不可或缺性。PCEA、SCEA和P/S三者联合检测对肺癌性胸腔积液的诊断有较高的敏感性,对疑似病例的快速、准确的鉴别诊断具有重要的辅助价值。
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| 关 键 词： | 胸腔积液 癌胚抗原 肺癌 结核性胸膜炎 临床诊断 |
Detection of carcinoembryonic antigen levels in pleural effusion and serum and theirratio for differential diagnosis of pleural effusion resulting from tuberculosis and lungcancer |
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| Abstract: | Objective To study the clinical value of detecting carcinoembryonic antigen levels in pleural effusion (PCEA) andserum (SCEA) and their ratio (P/S) in the differential diagnosis of pleural effusions resulting from tuberculosis and lungcancer. Methods This retrospectively study was conducted among 82 patients with pleural effusion caused by pulmonarytuberculous (TB; control group) and 120 patients with pleural effusion resulting from lung cancer in our hospital betweenApril, 2016 and March, 2018. PCEA, SCEA and P/S were compared between the two groups and among the subgroups of lungcancer patients with squamous cell carcinoma (SqCa), adenocarcinoma (ACA), small cell carcinoma (SCLC). The receiveroperatingcharacteristic curve (ROC) analysis was used to confirm the optimal critical value to evaluate the diagnosticefficiency of different combinations of PCEA, SCEA and P/S. Results PCEA, SCEA and P/S were significantly higher in theoverall cancer patients and in all the 3 subgroups of cancer patients than in the patients with TB (P<0.05). The areas under theROC curve of PCEA, SCEA and P/S were 0.925, 0.866 and 0.796, respectively; PCEA had the highest diagnostic value, whosediagnostic sensitivity, specificity, accurate rate, and diagnostic threshold were 83.33%, 96.34, 88.61%, and 3.26 ng/ml, respectively;SCEA had the lowest diagnostic performance; the diagnostic performance of P/S was between that of SCEA and PCEA, but itscombination with SCEA greatly improved the diagnostic performance and reduced the rates of misdiagnosis and misseddiagnosis. Parallel tests showed that the 3 indexes combined had significantly higher diagnostic sensitivity than each or anytwo of the single indexes (P<0.05), but the diagnostic specificity did not differ significantly. The area under the ROC curve ofcombined detections of the 3 indexes was 0.941 for diagnosis of lung cancer-related pleural effusion, higher than those of anyother combinations of the indexes. Conclusion The combined detection of PCEA, SCEA and P/S has a high sensitivity fordiagnosis of lung cancer-related pleural effusion and provides important information for rapid and accurate diagnosis ofsuspected cases. |
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