血清和胸水中肿瘤标志物检测对老年人胸腔积液的诊断价值  

Diagnostic value of CYFRA21-1,NSE,CA15-3,CA19-9 and CA125 assay in pleural effusions in elderly patients

作　　者：李长生[1] 程邦昌[2] 戈伟[3] 高建飞[4] 

机构地区：[1]武汉大学人民医院呼吸科,430060 [2]武汉大学人民医院胸外科,430060 [3]武汉大学人民医院肿瘤科,430060 [4]广州军区武汉总医院肿瘤科

出　　处：《中华老年医学杂志》2004年第10期697-700,共4页Chinese Journal of Geriatrics

摘　　要：目的　评价老年良、恶性胸腔积液患者血清和胸液中 5种肿瘤标志物单项和联合检测的诊断价值。　方法　采用酶联免疫吸附法同时检测 32例老年肺癌并胸腔积液 (恶性胸腔积液组 )和 30例老年良性胸腔积液患者血清和胸水中细胞角化素蛋白片段 19(CYFRA2 1 1)、神经元特异性烯醇化酶 (NSE)、糖链抗原 15 3(CA15 3)、糖链抗原 19 9(CA19 9)、糖链抗原 12 5 (CA12 5 )水平。　结果　恶性胸腔积液患者血清中上述 5项指标的水平分别为 ( 12 84± 6 4 8) μg/L、( 2 2 0 7± 11 2 5 )μg/L、( 6 5 74± 30 2 6 )kU/L、( 5 6 32± 2 5 6 7)kU/L和 ( 71 86± 31 4 5 )kU/L ,均高于良性胸腔积液患者血清中的水平 (P <0 0 1) ;恶性胸腔积液患者胸水中除NSE外 ,其他 4项指标的水平分别为 ( 18 6 4± 8 15 ) μg/L、( 5 9 31± 2 7 35 )kU/L、( 4 8 2 4± 2 1 5 6 )kU/L和 ( 6 2 16± 2 7 79)kU/L ,均高于良性胸腔积液患者胸水中的水平 (P <0 0 1) ;血清 5种肿瘤标志物平行联合检测可提高诊断的敏感性至90 6 % ,系列联合检测可使特异性提高至 93 3% ;胸液中 4项指标对恶性胸水诊断的敏感性和特异性分别是 :CYFRA2 1 184 4 %和 90 0 % ;CA15 36 2 5 %和 73 3% ;CA19 937 5 %和 6 6 7% ;CA12 55 6Objective The aim of this study was to evaluate the individual and combined diagnostic value of five tumor markers in the elderly patients with pleural effusion. Methods Serum and pleural levels of cytokeratin fragment19(CYFRA21 1), neuron specific enalase(NSE), carbohydrate antigen15 3(CA15 3), carbohydrate antigen19 9(CA19 9) and carbohydrate antigen 125(CA125) were assayed in 32 elderly patients with malignant pleural effusions resulting from advanced lung cancer and in 30 elderly patients with benign pleural effusions by ELISA. Results Serum levels of CYFRA21 1, NSE, CA15 3, CA19 9 and CA125 in patients with malignant pleural effusions were (12 84±6 48) μg/L, (22 07±11 25) μg/L, (65 74±30 26) kU/L, (56 32±25 67)kU/L and (71 86±31 45) kU/L, respectively and were significantly higher than those patients with benign pleural effusions (P<0 01). Pleural fluid levels of CYFRA21 1, CA15 3, CA19 9 and CA125 except NSE in patients with malignant pleural effusions were (18 64±27 79) μg/L, (59 31±27 35) kU/L, (48 24±21 56) kU/L and (62 16±27 79) kU/L, respectively and were significantly higher than those patients with benign pleural effusions (P<0 01). The parallel combined testing of five serum tumor markers increased the diagnostic sensitivity to 90 6%, and serial combined testing increased the diagnostic specificity to 93 3%. The sensitivity(%) and specificity (%) of these tumor markers in pleural fluid were CYFRA21 1, 84 4% and 90 0%,CA15 3, 62 5% and 73 3%, CA19 9, 37 5% and 66 7%, CA125; 56 3% and 70 0%, for differentiating malignant from benign effusions. When combined CYFRA21 1 and CA15 3, the sensitivity and specificity were increased (100% and 90%,respectively). Conclusions Five tumor markers in serum and pleural fluid show certain values in the diagnosis and differential diagnosis for malignant pleural effusions in the elderly patients. The combined assay of five tumor markers in serum and the CYFRA21 1 combined with CA15 3 in pleura

关 键 词：血清 诊断 恶性胸腔积液 胸水 患者 联合检测 老年人 水平 结论 单项 

分 类 号：R446.6[医药卫生—诊断学]