肿瘤标志物CEA、CYFRA21-1和NSE联合检测对老年人胸腔积液鉴别诊断的意义  

Value of combined detection of CEA,CYFRA21-1 and NSE in differential diagnosis of pleural effusion in elderly patients

作　　者：吴国成[1] 胡华成[2] 施敏骅[2] 胡筠珠[2] 

机构地区：[1]海军安庆医院呼吸内科,安徽省安庆市246003 [2]苏州大学附属第二医院呼吸内科,江苏省苏州市215004

出　　处：《实用老年医学》2008年第4期303-305,共3页Practical Geriatrics

摘　　要：目的评价老年良、恶性胸腔积液患者血清和胸液中3种肿瘤标志物单项和联合检测的诊断价值。方法采集有胸腔积液患者的血清及胸水样本各64例,其中恶性组34例,良性组30例,用放射免疫法检测其血清及胸水癌胚抗原(CEA)、细胞角蛋白19片断(CYFRA21-1)和神经元特异性烯醇化酶(NSE)的含量。结果恶性组血清和胸水中CEA、CYFRA21-1、NSE水平均显著高于良性组(P<0.01);血清中3项指标对恶性胸水诊断的敏感性和特异性:CEA为79.4%和86.7%;CYFRA21-1为79.4%和83.3%;NSE为70.6%和73.3%;胸水中3项指标对恶性胸水诊断的敏感性和特异性:CEA为82.4%和83.3%;CYFRA21-1为79.4%和80.0%;NSE为64.7%和70.0%;CYFRA21-1与CEA联合检测可使血清标志物敏感性和诊断符合率提高至97.1%和92.2%,胸水标志物提高至97.1%和90.6%;血清和胸水中3种肿瘤标志物平行联合检测可提高诊断的敏感性至100%,系列联合检测可使特异性提高至100%。结论肿瘤标志物CEA、CYFRA21-1和NSE的联合检测,对老年人胸腔积液的鉴别诊断有较高的临床价值,以CEA+CYFRA21-1组合为佳。Objective To evaluate the combined diagnostic value of three tumor markers in elderly patients with pleural effusion. Methods Sixty-four serum and 64 pleural fluid samples were collected from 64 patients with pleural effusion. Among them,34 patients presented with malignant pleural effusion and 30 patients with benign pleural effusion. The concentration of CEA,CYFRA21-1 and NSE was determined by immunoradiometric assay. Results The levels of CEA, CYFRA21-1 and NSE in serum and pleural fluid taken from patients with malignant pleural effusion were significantly higher than those from patients with benign pleural effusion（ P 〈 0. 01 ）. The diagnostic sensitivity and specificity of CEA, CYFRA21-1 ,NSE for malignant pleural effusion were as follows： 79.4% and 86. 7% ,79.4% and 83.3% ,70. 6% and 73.3% in serum,and 82.4% and 83.3% ,79.4% and 80. 0% ,64.7% and 70.0% in pleural fluid,respectively. The sensitivity and accuracy of CEA combined with CYFRA21-1 were increased to 97.1% and 92.2% in serum,97. 1% and 90. 6% in pleural fluid. The parallel combined testing of three tumor markers of serum and pleural fluid increased the sensitivity to 100%, and serial combined testing increased the diagnostic specificity to 100%. Condusious Tumor markers of CEA,CYFRA21-1 and NSE have high clinical values in the differential diagnosis of pleural effusion in elderly patients. The combined assay of CEA and CYFRA21-1 is recommended.

关 键 词：胸腔积液 肿瘤标志物 老年人 

分 类 号：R561[医药卫生—呼吸系统]