胸腔积液脱落细胞学检查及肿瘤标志物检测对肺良恶性病变的鉴别诊断价值  

Differential diagnostic value of exfoliated cytology examination and tumor markers in pleural effusion for benign and malignant lung lesions

作　　者：常文龙[1] 刘欢欢 庞永阳 张斌斌 王耀林 CHANG Wenlong;LIU Huanhuan;PANG Yongyang;ZHANG Binbin;WANG Yaolin(Department of Endocrine Laboratory,Baoding No.1 Central Hospital,Baoding 071000,Hebei,China;Second Department of Respiratory and Critical Care Medicine,Baoding No.1 Central Hospital,Baoding 071000,Hebei,China)

机构地区：[1]保定市第一中心医院内分泌实验室,河北保定071000 [2]保定市第一中心医院呼吸与危重症二科,河北保定071000

出　　处：《癌症进展》2023年第17期1910-1913,1921,共5页Oncology Progress

基　　金：保定市科学技术研究与发展指导计划项目(17ZF001)。

摘　　要：目的探讨胸腔积液脱落细胞学检查及肿瘤标志物检测对肺良恶性病变的鉴别诊断价值。方法选取96例肺部疾病患者,均行胸腔积液脱落细胞学检查及胸腔积液肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、神经元特异性烯醇化酶(NSE)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]检测。比较肺癌与肺良性病变患者、不同病理类型肺癌患者胸腔积液肿瘤标志物水平。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估胸腔积液脱落细胞学检查、肿瘤标志物检测对肺癌的诊断效能。结果病理结果显示,肺癌51例,肺良性病变45例。51例肺癌患者经胸腔积液脱落细胞学检查发现肿瘤细胞41例(80.39%),32例经一次送检确诊,9例为两次或以上送检确诊。肺癌患者胸腔积液CEA、NSE、CYFRA21-1、CA19-9、CA125水平均明显高于肺良性疾病患者,差异均有统计学意义(P﹤0.01)。腺癌患者胸腔积液CEA、CA125水平均高于鳞状细胞癌和小细胞癌患者,小细胞癌患者CEA、CA125水平均高于鳞状细胞癌患者,差异均有统计学意义(P﹤0.05);小细胞癌患者胸腔积液NSE、CA19-9水平均高于腺癌和鳞状细胞癌患者,鳞状细胞癌患者胸腔积液CA19-9水平高于腺癌患者,差异均有统计学意义(P﹤0.05);鳞状细胞癌患者胸腔积液CYFRA21-1水平高于腺癌和小细胞癌患者,小细胞癌患者CYFRA21-1水平高于腺癌患者,差异均有统计学意义(P﹤0.05)。胸腔积液脱落细胞学检查诊断肺癌的AUC为0.902(95%CI:0.824~0.953),高于各肿瘤标志物单独检测,各肿瘤标志物诊断肺癌的AUC由高到低依次为CA19-9、CEA、CYFRA21-1、CA125、NSE。结论胸腔积液脱落细胞学检查对肺癌的诊断效能最高,但临床为了减少漏诊可结合肿瘤标志物检测以提高肺癌的诊断准确度。Objective To investigate the differential diagnostic value of exfoliated cytology examination and tumor markers in pleural effusion for benign and malignant lung lesions.Method A total of 96 patients with pulmonary diseas-es were selected.All patients underwent exfoliated cytology examination of pleural effusion,and the levels of tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 19-9(CA19-9),neu-ron specific enolase(NSE),cyto-keratin 19 fragment antigen 21-1(CYFRA21-1)]in pleural effusion were detected.The levels of tumor markers in patients with lung cancer and benign lung lesions,and lung cancer with different pathological types in pleural effusion were compared.The receiver operating characteristic(ROC)curve was plotted and the area un-der the curve(AUC)was calculated to evaluate the diagnostic efficiency of exfoliated cytology and tumor markers in pleural effusion for lung cancer.Result The pathological results showed that there were 51 cases of lung cancer and 45 cases of benign lung lesions.Fifty-one lung cancer patients were found to have tumor cells in 41 cases(80.39%)through pleural effusion exfoliated cytology examination,32 cases were confirmed by one test,and 9 cases were confirmed by two or more tests.The levels of CEA,NSE,CYFRA21-1,CA19-9 and CA125 in pleural effusion of lung cancer patients were significantly higher than those of patients with benign lung diseases(P<0.01).The levels of CEA and CA125 in ade-nocarcinoma patients were higher than those in squamous cell carcinoma and small cell carcinoma patients(P<0.05),and the levels of CEA and CA125 in small cell carcinoma patients were higher than those in squamous cell carcinoma patients(P<0.05).The levels of NSE and CA19-9 in small cell carcinoma patients were higher than those in adenocarcinoma and squamous cell carcinoma patients(P<0.05),and the level of CA19-9 in squamous cell carcinoma patients was higher than that in adenocarcinoma patients(P<0.05).The level of CYFRA21-1 in patients with squamou

关 键 词：胸腔积液 脱落细胞学检查 肿瘤标志物 肺癌 

分 类 号：R734.2[医药卫生—肿瘤]