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目的探讨多项肿瘤标记物联合检测在良恶性胸水鉴别及肺癌诊断中的应用。方法采用电化学发光法检测石家庄市第一医院2012年3月至2014年3月共110例患者(因胸水待查收治入院)胸水中肿瘤标记物糖蛋白抗原199(CA199)、糖蛋白抗原125(CA125)、癌胚抗原(CEA)、神经元特异度烯醇化酶(NSE)、细胞角蛋白-19片段抗原(CYFRA21-1)含量,并比较多项肿瘤标记物联合检测在鉴别良恶性胸水应用中的灵敏度与特异度。结果良性胸水组患者胸水中肿瘤标记物的值均在正常值内,恶性胸水组患者胸水中CA199、CA125、CEA、NSE、CYFRA21-1含量分别为(68.2±9.3)U/ml、(66.5±10.7)U/ml、(127.6±25.6)ng/ml、(27.8±3.6)ng/ml、(76.4±8.3)ng/ml,均显著高于良性胸水组患者,差异有统计学意义(P<0.05);CA199+CA125+CEA+NSE+CYFRA21-1联合检测可将灵敏度提高至85.0%,特异度可达到96.0%,阳性预测值为96.2%,阴性预测值为84.2%,均高于单项检测。结论胸水中肿瘤标记物联合检测可提高恶性胸水的诊断率,减少漏诊及误诊的发生,值得临床推广应用。
Objective To explore the combination of multiple tumor markers in the differential diagnosis of benign and malignant pleural effusion and the diagnosis of lung cancer. Methods Electrochemiluminescence was used to detect the tumor markers Glycoprotein 199 (CA199), Glycoprotein Antigen 125 in pleural effusion from 110 patients (admitted to the hospital for treatment of pleural effusion) from March 2012 to March 2014 in Shijiazhuang First Hospital from March 2012 to March 2014. (CA125), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and cytokeratin-19 fragment antigen (CYFRA21-1) were measured and compared with multiple tumor markers in the differential diagnosis of benign and malignant pleural effusion Sensitivity and specificity in applications. Results The values of tumor markers in pleural effusion were all within the normal range in patients with benign pleural effusion. The levels of CA199, CA125, CEA, NSE and CYFRA21-1 in pleural effusion in patients with malignant pleural effusion were 68.2 ± 9.3 U / ml and 66.5 ± 10.7) were significantly higher than those in benign pleural effusion group (P <0.01), and the difference was statistically significant (P < 0.05). The combined detection of CA199 + CA125 + CEA + NSE + CYFRA21-1 could increase the sensitivity to 85.0%, the specificity to 96.0%, the positive predictive value to 96.2% and the negative predictive value to 84.2% . Conclusion Combined detection of tumor markers in pleural effusion can improve the diagnostic rate of malignant pleural effusion and reduce the missed diagnosis and misdiagnosis, which deserves clinical application.