多层螺旋CT联合T-spot、血清肿瘤标志物对鉴别良恶性胸膜病变的诊断价值  

The value of multi-slice spiral CT combined with T-spot and serum tumor markers in differentiating tuberculous pleuritis from malignant pleural lesions

作　　者：李洋 朱朝辉 LI Yang;ZHU Zhaohui(Xinjiang Uygur Autonomous Region Infectious Diseases Hospital,Radiology Department,Urumqi,830049,China)

机构地区：[1]新疆维吾尔自治区传染病医院放射科,乌鲁木齐830049

出　　处：《新疆医学》2025年第1期14-18,共5页Xinjiang Medical Journal

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题项目(项目编号:SKL-HIDCA-2021-BF1)。

摘　　要：目的 探讨多层螺旋CT(MSCT)联合外周血结核检测T细胞斑点试验(T-spot)、血清肿瘤标志物对鉴别结核性胸膜炎与恶性胸膜病变的价值。方法 选取医院收治的78例结核性胸膜炎患者(结核性胸膜炎组)、65例恶性胸膜病变患者(恶性胸膜病变组),两组均经胸膜活检确诊,入院时行SCT、外周血T-spot、血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原153(CA153)]检测,对比两组血清肿瘤标志物水平差异,检验恶性胸膜病变阈值,分析MSCT联合外周血T-spot、血清肿瘤标志物对结核性胸膜炎与恶性胸膜病变的鉴别价值。结果 恶性胸膜病变组CEA、CA199、CA153水平较结核性胸膜炎组高(P<0.05);绘制ROC曲线发现,以CEA≥5.165ng/ml、CA199≥37.310U/ml、CA153≥27.165U/ml为结核性胸膜炎、恶性胸膜病变诊断阈值,三者诊断恶性胸膜病变均有一定诊断价值;依据病理结果,MSCT、外周血T-spot、血清肿瘤标志物联合检查与病理结果有极好的一致性;MSCT联合外周血T-spot、血清肿瘤标志物鉴别结核性胸膜炎与恶性胸膜病变的灵敏度、特异度、准确度高于各项单独诊断(P<0.05)。结论 MSCT联合外周血T-spot、血清肿瘤标志物检测对结核性胸膜炎与恶性胸膜病变具有较高诊断价值。ObjectiveTo investigate the value of multilayer CT(MSCT) combined with peripheral blood tuberculosis T cell spot test(T-spot) and serum tumor markers to distinguishing tuberculous pleurisy from malignant pleural lesions.MethodsSelected 78 patients(group) and 65 patients with malignant pleural lesions(group group), Both groups were confirmed by pleural biopsy, SCT, T-spot in peripheral blood, serum tumor markers [carcinoembryonic antigen(CEA), sugar antigen 199(CA199), sugar antigen 153(CA153)]were performed on admission, Comparing the differences in serum tumor marker levels between the two groups, To examine the threshold values for malignant pleural lesions, The differential value of MSCT combined with T-spot in peripheral blood and serum tumor markers between tuberculous pleuritis and malignant pleural lesions was analyzed.ResultsThe levels of CEA, CA199 and CA153 in malignant pleural lesions were higher than those in tuberculous pleurisy(P <0.05);Ptting the ROC curve found, Using CEA≥5.165ng/ml, CA199≥37.310U/ml, CA153≥27.165U/ml as the threshold for the diagnosis of tuberculous pleurisy and malignant pleural lesions,The three diagnosis of malignant pleural lesions have a certain diagnostic value;Based on the pathological findings, The combination of MSCT, peripheral blood T-shot, and serum tumor markers showed excellent agreement with the pathological results;MSCT combined with T-spot in peripheral blood and serum tumor markers had higher sensitivity, specificity and accuracy in distinguishing tuberculous pleurisy from malignant pleural lesions than each diagnosis alone(P <0.05).ConclusionMSCT combined with peripheral T-spot and serum tumor markers should have high diagnostic value for tuberculous pleurisy and malignant pleural lesions.

关 键 词：结核性胸膜炎 恶性胸膜病变 多层螺旋CT 外周血结核检测T细胞斑点试验 血清肿瘤标志物 鉴别价值 

分 类 号：R445.3[医药卫生—影像医学与核医学]