基于现场细胞学内科胸腔镜联合分子标志物在胸腔积液诊断中的应用研究  

Study on the application of medical thoracoscopy based on field cytology combined with molecular markers in the diagnosis of pleural effusion

作　　者：王红景 王彩彩[2] 唐茜 李振生[1] 白子娜 李星虹 王钧[1] 张乐天[1] 贺向红[3] WANG Hong-jing;WANG Cai-cai;TANG Qian(不详;The Second Department of Respiratory,Hebei Chest Hospital,Shijiazhuang 050048,China)

机构地区：[1]河北省胸科医院呼吸二科,河北石家庄050048 [2]河北省胸科医院呼吸三科,河北石家庄050048 [3]河北省胸科医院结核内科,河北石家庄050048

出　　处：《中国医学装备》2022年第9期94-97,共4页China Medical Equipment

基　　金：河北省医学科学研究课题计划(20190994)“内科胸腔镜联合现场细胞学在胸腔诊断中的应用”。

摘　　要：目的:分析探讨基于现场细胞学内科胸腔镜联合分子标志物在胸腔积液诊断中的应用。方法:选取医院收治的50例病因不明的胸腔积液患者,根据胸腔穿刺结果将其分为良性组(29例)和恶性组(21例)。所有患者均接受癌胚抗原(CEA)、糖类抗原(CA19-9)、鳞状细胞癌抗原(SCC-Ag)、细胞角蛋白19片段(CYFRA21-1)、胃泌素释放肽前体(ProGRP)等分子标志物检测诊断和现场细胞学内科胸腔镜诊断。比较两组胸腔积液患者分子标志物CA125、SCC-Ag、CYRA21-1、ProGRP及CEA水平变化,分析分子标志物水平诊断及其与现场细胞学内科胸腔镜联合诊断良恶性细胞的价值。以病理诊断结果为“金标准”,采用Kappa检验评价现场细胞学内科胸腔镜诊断、分子标志物与病理结果的一致性。结果:恶性组患者CA125、SCC-Ag、CYRA21-1、ProGRP及CEA水平明显高于良性组(t=7.526,t=11.650,t=23.047,t=292.680,t=34.801;P<0.05)。恶性组中分子标志物诊断的灵敏度、特异度和符合率分别为66.67%、82.75%和76.00%;现场细胞学内科胸腔镜诊断分别为80.95%、89.66%和86.00%;现场细胞学内科胸腔镜联合分子标志物诊断分别为90.48%、93.10%和92.00%。分子标志物、现场细胞学内科胸腔镜和两者联合诊断结果与“金标准”的一致性Kappa值分别为0.628,0.859和0.947。结论:现场细胞学内科胸腔镜联合分子标志物诊断结果与“金标准”具有较高一致性,对不明胸腔积液的诊断具有较高的价值,且安全性较高,可有效提高临床诊疗的准确性。Objective:To analyze and explore the application of medical thoracoscopy based on field cytology combined with molecular markers in the diagnosis of pleural effusion.Methods:A total of 50 patients with pleural effusion whose etiology were unknown and admitted to hospital were selected and they were divided into benign group(29 cases)and malignant group(21 cases)according to the results of thoracentesis.All patients received the diagnostic detections of molecular marker included carcinoembryonic antigen(CEA),carbohydrate antigen(CA19-9),squamous cell carcinoma antigen(SCC-Ag),cytokeratin 19 fragment(CYFRA21-1)and precursor gastrin-releasing peptide(ProGRP),and on-field cytology medical thoracoscopy diagnosis.And the changes of CA125,SCC-Ag,CYRA21-1,ProGRP and CEA of molecular markers of patients with pleural effusion between two groups were compared,and the diagnostic values of molecular markers and the combination of that and on-field cytology medical thoracoscopy were analyzed in diagnosing benign and malignant disease.The results of pathological diagnosis was used as gold standard,and Kappa test was adopted to evaluate the consistencies between on-field cytology medical thoracoscopy and the pathological results,and between molecular markers and that.Results:The levels of CA125,SCC-Ag,CYRA21-1,ProGRP and CEA in malignant group were significantly higher than those in benign group(t=7.526,t=11.650,t=23.047,t=292.680,t=34.801,P<0.05).The diagnostic sensitivity,specificity and coincidence rate of molecular markers in malignant group were 66.67%,82.75%and 76.00%,respectively.The diagnostic sensitivity,specificity and coincidence rate of on field cytology medical thoracoscopy were 80.95%,89.66%and 86.00%in malignant group,respectively.And the diagnostic sensitivity,specificity and coincidence rate of on field cytology medical thoracoscopy combined with molecular markers were 90.48%,93.10%and 92.00%in malignant group,respectively.In addition,the consistencies between gold standard and molecular marker,and between that

关 键 词：现场细胞学 内科胸腔镜 分子标志物 胸腔积液 诊断 

分 类 号：R561[医药卫生—呼吸系统]