超声引导胸膜穿刺组织活检联合胸腔积液生化检查在恶性和结核性胸腔积液鉴别诊断中的价值  

The diagnostic value of ultrasound-guided pleural biopsy combined with biochemical detections in pleural effusions of malignant and tuberculous origin

作　　者：窦健萍 徐建红[2] 费翔[2] 范春芝 徐涛[1] 胡剑秋[2] 唐杰[1] 温朝阳[2] 

机构地区：[1]解放军总医院超声科,北京100853 [2]解放军总医院海南分院超声科 [3]北京市朝阳医院超声科

出　　处：《中华医学超声杂志（电子版）》2014年第3期54-58,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：海南省医学普通科研立项课题(琼卫2012PT-74)

摘　　要：目的分析超声引导胸膜穿刺组织活检联合胸腔积液生化检查在恶性和结核性胸腔积液鉴别诊断中的价值。方法选取64例中至大量胸腔积液合并胸膜增厚患者,根据术前胸部CT的检查结果,超声再次寻找可疑胸膜病变处,以选择合适的穿刺路径,并在超声引导下行斜行胸膜穿刺组织活检术,送病理检查以获取病理分型。完成胸膜活检后,进行胸腔积液的抽吸或置管引流,胸腔积液送生化等检查。采用成组设计两样本均数的t检验统计分析恶性和结核性胸腔积液内癌胚抗原、CA125、CYFRA21、乳酸脱氢酶水平的差异;采用完全随机设计两样本率比较的χ2检验分析恶性和结核性胸腔积液中的癌胚抗原、CA125、CYFRA21、乳酸脱氢酶阳性率的差异。结果 64例患者均一次成功取到胸膜组织,超声引导胸膜穿刺组织活检取材成功率为100%(64/64),有73%(46/64)的患者超声引导胸膜穿刺组织活检病理明确诊断为肿瘤性或结核性胸腔积液。经临床综合评价,64例病例中,27例确诊为恶性胸腔积液,37例诊断为结核性胸腔积液。癌胚抗原、CA125、CYFRA21、乳酸脱氢酶在恶性胸腔积液中的阳性率分别为100%(27/27)、100%(27/27)、100%(27/27)、89%(24/27),在结核性胸腔积液中的阳性率分别为0%(0/37)、84%(31/37)、78%(29/37)、76%(28/37),在恶性和结核性胸腔积液中癌胚抗原、CA125、CYFRA21阳性率的差异均有统计学意义(χ2=64.0、3.1、4.8,P均<0.05)。癌胚抗原、CA125、CYFRA21、乳酸脱氢酶在恶性胸腔积液中的水平分别为(727.1±658.8)μg/L、(795.2±1249.6)kU/L、(296.2±320.7)μg/L、(1 077.9±1 058.5)U/L,在结核性胸腔积液中的水平分别为(1.7±1.1)μg/L、(336.3±208.6)kU/L、(20.7±14.9)μg/L、(309.2±182.7)U/L,在恶性和结核性胸腔积液中癌胚抗原、CYFRA21、乳酸脱氢酶水平的差异均有统计学意义(t=45.1、27.4、18.8,P均<0.01)。结论超声引导胸膜穿刺组织活检联合癌胚�Objective To evaluate the diagnostic value of ultrasound-guided pleural biopsy combined with thoracic biochemical detections in malignant and tuberculous pleural effusions. Methods Sixty-four patients with moderate or large pleural effusions and pleural thickening received the ultrasound-guided diagnostic pleural biopsy. All patients had chest CT enhancement scans to find out the suspicious pleural thickening preoperatively, facilitating the selection of puncture sites by ultrasound. Pleural tissue samples were sent for pathological examinations immediately. After successful achievements of pleural biopsy, ultrasound-guided aspiration or drainage was performed to alleviate symptoms, more importantly, to get pleural effusions for biochemical analysis. Biological results including carcinoembryonic antigen（CEA）, CA125, CYFRA21 and lactate dehydrogenase（LDH） in malignant and tuberculous effusions were analyzed by group design t tests. The positive rates of CEA, CA125, CYFRA21, LDH in malignant and tuberculous effusions were compared by chi square tests. Results Pleural tissues in all cases were got by one pleural biopsy procedure. The strategy of pleural biopsy we used in this study had a successful rate reaching 100%（64/64）, and 73% （46/64） patients had a definitive diagnosis as malignant or tuberculous effusion. Twenty-seven cases were diagnosed as malignant effusions and thirty-seven cases as tuberculous effusions based on the definitive clinical diagnosis. The positive rates of CEA, CA125, CYFRA21, LDH in malignant effusions were 100%（27/27）, 100%（27/27）, 100%（27/27）, 89%（24/27） respectively, and 0%（0/37）, 84%（31/37）, 78%（29/37）, 76%（28/37） respectively in tuberculous effusions. The positive rate of CEA between malignant and tuberculous effusions differed significantly （x^2=64.0, P 〈 0.01）, so did CA125 （x^2=3.1, P 〈 0.01） and CYFRA21（x^2=4.8, P〈0.01）. The average levels of CEA, CA125, CYFRA21, LDH in pleural effusion were （727.1±658.8） lag/L,

关 键 词：超声检查 活组织检查 针吸 生物学标记 胸水 

分 类 号：R446.8[医药卫生—诊断学]