胸水DNA倍体联合细胞角蛋白-19片段检测对良恶性肺部疾病的鉴别诊断意义  

Differential diagnosis of benign and malignant lung diseases by DNA ploidy combined with cytokeratin-19 fragment detection in pleural fluid

作　　者：朱涛 王兆丰 ZHU Tao;WANG Zhaofeng(Department of Clinical Laboratory,Zhejiang Rongjun Hospital,Jiaxing 314001,China)

机构地区：[1]浙江省荣军医院检验科,嘉兴314001

出　　处：《浙江医学》2024年第18期1954-1958,I0004,共6页Zhejiang Medical Journal

基　　金：嘉兴市科技计划项目(2021AD30082)。

摘　　要：目的探讨胸水DNA倍体联合细胞角蛋白-19片段(CYFRA-21-1)检测对良恶性肺部疾病的鉴别诊断意义。方法回顾性分析2021年5月1日至2023年12月1日浙江省荣军医院收治确诊为非小细胞肺癌伴胸水的患者78例作为病例组,同时纳入同期入院存在胸水的肺部良性疾病患者50例作为对照组。对所有患者的胸水及外周血标本进行DNA倍体及CYFRA-21-1阳性率的检测,并统计比较外周血及胸水标本中DNA倍体、CYFRA-21-1单一检测与联合检测的效能。结果病例组胸水、外周血的DNA倍体和CYFRA-21-1阳性率均明显高于对照组,差异均有统计学意义(均P<0.05);病例组胸水DNA倍体和CYFRA-21-1的阳性率均明显高于外周血,差异均有统计学意义(均P<0.05);胸水DNA倍体联合CYFRA-21-1鉴别良恶性肺部疾病的AUC为0.980,大于单一指标胸水DNA倍体的AUC 0.964和胸水CYFRA-21-1的AUC 0.900,差异均有统计学意义(均P<0.05);胸水DNA倍体联合CYFRA-21-1检测鉴别良恶性肺部疾病的灵敏度为1.00,特异度为0.96,准确度为0.98。结论肺癌患者胸水出现DNA异常增殖及CYFRA-21-1阳性率增高且远早于外周血标本,胸水DNA倍体及胸水CYFRA-21-1联合检测有助于提高良恶性肺部疾病的鉴别诊断效能,值得予以重视应用。Objective To investigate the significance of detecting DNA ploidy combined with cytokeratin-19 fragment(CYFRA-21-1)in pleural fluid on differential diagnosis of benign and malignant lung diseases.Methods A retrospective analysis was performed on 78 patients diagnosed with non-small cell lung carcinoma and pleural effusion admitted to Zhejiang Rongjun Hospital from May 1,2021 to December 1,2023 as the case group,and 50 patients with benign lung disease and pleural effusion who were admitted to the hospital during the same period as the control group.DNA ploidy and CYFRA-21-1 in pleural fluid and peripheral blood samples of all patients were detected,and the efficacy of DNA ploidy and CYFRA-21-1 in peripheral blood and pleural fluid samples was statistically compared.Results The positive rates of DNA ploidy and CYFRA-21-1 in pleural effusion and peripheral blood in the case group were all significantly higher than those in the control group,and the differences were statistically significant(all P<0.05).In the case group,the positive rates of DNA ploidy and CYFRA-21-1 in pleural fluid were significantly higher than those in peripheral blood(both P<0.05);The AUC of pleural fluid DNA ploidy combined with CYFRA-21-1 in the identification of benign and malignant lung diseases was 0.980,which was greater than that of the single index of pleural fluid DNA ploidy(0.964)and that of pleural fluid CYFRA-21-1(0.900;both P<0.05);the sensitivity,specificity,and accuracy of the detection of benign and malignant lung diseases by pleural fluid DNA ploidy combined with CYFRA-21-1 were 1.00,0.96,and 0.98,respectively.Conclusion The abnormal DNA proliferation and increased positive rate of CYFRA-21-1 are found in pleural fluid of lung carcinoma patients,which are much earlier than those of peripheral blood specimens.The combined detection of pleural fluid DNA ploidy and CYFRA-21-1 can help improve the differential diagnosis between benign and malignant lung diseases,which deserves attention.

关 键 词：肺癌 DNA倍体 胸水 流式细胞术 细胞角蛋白-19片段 

分 类 号：R734.2[医药卫生—肿瘤]