血清和胸腔积液中癌胚抗原水平诊断恶性胸腔积液价值的再评价  

Evaluation of the diagnosis value of carcinoembryonic antigen in malignant pleural effusion

作　　者：尉艳霞[1] 童朝晖[1] 周晓霞[2] 梁立荣[1] 王臻[1] 徐莉莉[1] 王晓娟[1] 伍燕兵[1] 李红杰[1] 芦展[1] 

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科北京呼吸疾病研究所,100020 [2]首都医科大学附属北京复兴医院老年科

出　　处：《中华医学杂志》2018年第6期432-435,共4页National Medical Journal of China

摘　　要：目的评价血清和胸腔积液中癌胚抗原（CEA）水平诊断恶性胸腔积液的价值。方法回顾性分析286例经内科胸腔镜胸膜活检病理确诊为恶性胸腔积液171例（腺癌组121例及非腺癌组50例）和良性胸腔积液（良性组115例）患者血清和胸腔积液CEA水平，应用受试者工作曲线（ROC曲线）确定恶性胸腔积液患者以及腺癌所致恶性胸腔积液患者血清和胸腔积液CEA水平的最佳临界值。结果腺癌组血清CEA水平均显著高于非腺癌组及良性组[12．27（3．80，58．45）比1．91（1．08，4．55）及1．32（0．86，2．27）μg/L，均P〈0．001]，而非腺癌组与良性组差异无统计学意义（P=0．728）。腺癌组胸腔积液CEA水平均显著高于非腺癌组及良性组[160．70（30．48，1000．00）比1．77（0．51，11．39）及1．09（0．60，1．68）μg/L，均P〈0．001]，非腺癌组显著高于良性组（P〈0．05）。以ROC曲线确定血清和胸腔积液CEA水平诊断恶性胸腔积液的最佳临界值分别为3．10和5．83μg/L，灵敏度分别为67．3％和74．3％，特异度分别为87．8％和98．3％，阳性预测值分别为89．2％和98．5％，阴性预测值分别为64．3％和72．0％。而血清和胸腔积液CEA水平诊断腺癌所致恶性胸腔积液的最佳临界值为3．54和7．30μg/L，灵敏度分别为76．0％和91．7％，特异度分别为74．0％和72．0％，阳性预测值分别为87．6％和88．8％，阴性预测值分别为56．1％和78．3％。结论血清和胸腔积液CEA水平对恶性胸腔积液均有重要的诊断价值；胸腔积液CEA水平对腺癌所致恶性胸腔积液的诊断价值优于血清CEA水平。Objective To investigate the diagnostic value of serum and pleural fluid carcinoembryonic antigen （CEA） for malignant pleural effusion （MPE）. Methods The concentration of CEA in serum and pleural fluid of 286 patients with the diagnosis confirmed by pleural biopsy through medical thoracoscopy were retrospectively analyzed. MPE was confirmed in 171 cases which were divided into two groups （adenocareinoma group with 121cases and non-adenoearcinoma group with 50 cases） and benign pleural effusion in 115 cases. The optimal cutoff for MPE and MPE caused by adenoearcinoma were determined by using the ROC curve. Results The concentration of serum CEA 12. 27 （3.80, 58.45 ）μg/L was significantly higher in MPE caused by adenoearcinoma than that of non-adenoearcinoma l. 91 （ 1.08, 4. 55 ） μg/L and benign effusion 1.32（0. 86, 2. 27） txg/L （ both P 〈0. 001 ）, but there was no statistically significant difference between benign and non-adenocarcinoma effusion （ P = 0. 728 ）. The concentration of pleural fluid CEA 160. 70 （30.48, 1 000. 00） μg/L was significantly higher iu MPE caused by adenocareinoma than that of non-adenocarcinoma 1.77 （0. 51, 11.39） μg/L and benign effusion 1.09 （0. 60, 1.68） μg/L （both P〈 0. 001 ）, and higher in non-adenocareinoma effusion than that of benign effusion （P 〈0. 05）. The cutoff value of serum and pleural fluid CEA for MPE was 3.10 and 5.83 μg/L, the sensitivity respectively was 67.3% and 74. 3% , the specificity respectively was 87.8% and 98.3% ,positive predictive value respectively was 89. 2% and 98.5% , negative predictive value respectively was 64. 3% and 72.0%. The cutoff value of serum and pleural fluid CEA for MPE caused by adenocarcinoma was 3.54 and 7.30 μg/L, the sensitivity respectively was 76. 0% and 91.7%, the specificity respectively was 74. 0% and 72.0%, positive predictive value respectively was 87.6% and 88. 8%, negative predictive value respectively was 56. 1% and 78.3%. Conclusions The concentration of serum and

关 键 词：癌胚抗原 胸腔积液 恶性 胸腔镜 ROC曲线 

分 类 号：R730.43[医药卫生—肿瘤]