CYFRA 21-1,HER-2/neu及NSE在胸腔积液鉴别诊断中的价值  

Clinical value of CYFRA 21-1,HER-2/neu and NSE in differential diagnosis of pleural effusion

作　　者：林桦[1] 丘世飏[2] 孙圣华[1] 

机构地区：[1]中南大学湘雅三医院呼吸内科,湖南长沙410013 [2]中南大学湘雅医院检验科,湖南长沙410008

出　　处：《细胞与分子免疫学杂志》2010年第8期767-770,共4页Chinese Journal of Cellular and Molecular Immunology

基　　金：湖南省卫生厅科研基金资助项目(B2007026)

摘　　要：目的：探讨肿瘤标志物细胞角蛋白片段抗原21—1（CYFRA 21—1）、人体表皮生长因子受体-2（HER-2／neu）和神经元烯醇化酶（NSE）对良、恶性胸水鉴别诊断的临床应用价值。方法：分别用放射免疫法及ELISA法，定量检测62例恶性及48例良性胸腔积液患者血清和胸腔积液中CYFRA 21-1、HER-2／neu和NSE的含量。通过受试者工作特征（ROC）曲线分析各指标的临床性能，并确定其截断点（cut off value）。结果：恶性胸水患者血清及胸水中CYFRA 21—1、HER-2／neu和NSE的含量均显著高于良性胸水患者（P〈0．01）。胸腔积液中CYFRA 21—1、HER-2／neu和NSE的含量明显高于血清（P〈0．01或0．05）。各指标的截断点分别为：血清NSE为11．40μg／L，胸腔积液NSE为16．47μg／L；血清CYFRA 21—1为4．94μg/L，胸腔积液CYFRA 21—1为7．70μg／L；血清HER-2／neu为2．50μg／L，胸腔积液HER-2／neu为3．50μg／L。单独检测血清和胸腔积液CYFRA 21—1、HER-2／neu和NSE的ROC曲线下面积，分别为0．852、0．932，0．867、0．887和0．773、0．846，两两联合检测可使ROC曲线下面积增大，3项指标联合检测的ROC曲线下面积高达0．999。结论：检测胸水中的CYFRA 21—1、HER-2／neu和NSE，对良、恶性胸水的鉴别诊断具有一定的临床意义。运用ROC曲线分析可确定各项检测指标的截断点，科学地服务于临床。单个指标的检测有一定的局限性，只有综合利用多项检测指标对患者作出诊断，才能提高诊断的准确性。AIM： To explore the clinical value of CYFRA 21-1, HER-2/neu and NSE as tumor markers for differential diagnosis of malignant and benign pleural effusion. METHODS： Radioimmunoassay and ELISA were used to detect the serum and effusion levels of CYFRA 21-1, HER-2/neu and NSE in 62 patients with malignat pleural effusion and 48 patients with benign pleural effusion. The clinical properties were analyzed and the cut off values were determined through receiver operating characteristic（ROC） curve. RESULTS ： The levels of CYFRA 21-1, HER-2/neu and NSE in serum and pleural effusion in malignant groups were significant higher than those in benign group （ P 〈 0. 01 ）. The levels of CYFRA 21-1, HER-2/neu and NSE in pleural effusion were obviously higher than those in serum （ P 〈 0.01 or 0.05）. The cut off value of NSE in serum was 11.40 μg/L, While the cut off value of NSE in pleural effusion was 16.47μg/L. The cut off values of CYFRA 21-1 in serum and in pleural effusion were 4.94 μg/L and 7.70μg/L respectively. The cut off values of HER-2/neu in serum and in pleural effusion were 2.50 μg/L and 3.50 μg/L, respectively. Independent examination of the levels of CYFRA 21-1, HER-2/ neu and NSE in serum and pleural effusion showed that the area under ROC curve was （0. 852, 0. 932）, （0. 867, 0. 887） and （0. 773, 0. 846）, respectively. Double-combined detection enlarged the area under ROC curve, while three-combined detection caused an increase in the area under ROC curve up to O. 999. CONCLUSION： The detection of CYFRA 21-1, HER-2/neu and NSE in pleural effusion has certain clinical significance in differential diagnosis of malignant and benign effusions. ROC curve can be used to determine the cut off values. Given the limitation of single index, comprehensive application of multiple indexes may increase the accuracy of diagnosis.

关 键 词：细胞角蛋白片段抗原21-1 人体表皮生长因子受体-2 神经元烯醇化酶 胸腔积液 鉴别诊断 受试者工作特征(ROC)曲线 

分 类 号：R730.4[医药卫生—肿瘤]