良恶性胸腔积液多指标联检鉴别的临床探讨  

THE IMPLICATION OF MULTIPLE ASSAYS IN DIFFERENTI-ATION OF BENIGN FROM MALIGNANT HYDROTHORAX

作　　者：杨敬平[1] 孙德俊[1] 王秀香[1] 李淑君[1] 米天明[1] 徐喜媛[1] 

机构地区：[1]内蒙古医学院第三附属医院呼吸科,内蒙古包头014010

出　　处：《内蒙古医学院学报》2003年第2期78-81,共4页Acta Academiae Medicinae Neimongol

摘　　要：目的 :探讨胸膜活检术、糖链抗原 5 0 ( CA50 )、唾液酸 ( TSA)、铁蛋白 ( SF)、癌胚抗原 ( CEA)、染色体检查及其联检 ,对良恶性胸腔积液的诊断价值。方法 :将胸腔积液病人 74例分为结核性组 ( A组 40例 )及恶性组( B组 3 4例 ) ,胸腔积液的 CEA、CA50 、SF、TSA采用放免法测定 ,利用短期培养法行胸腔积液细胞染色体分析 ,行胸膜活检术 ,观察胸膜活检阳性率、两组胸腔积液检查及联检的特异性及灵敏度。结果 :胸膜活检 A组阳性率60 % ,B组阳性率 5 0 %。B组的 CA50 、TSA、SF、CEA测定值较 A组明显增高 ( P <0 .0 1及 P <0 .0 0 1 )。A组及B组胸膜活检阳性率分别为 60 %及 5 0 %。 B组三项、五项联检灵敏度分别为 88%、76% ,较单项检验差异显著( P <0 .0 5 )。三项联检特异性为 95 % ,较单项检验差异显著 ( P <0 .0 5 )。结论 :恶性胸腔积液检测 CEA、TSA灵敏度较高 ,而 CEA、CA50 特异性较高。如单选某项检查或胸膜活检漏诊率为 5 0 %～ 80 %。胸腔积液三项联检对筛选出恶性胸腔积液意义较大 。Objective: To discuss the role of pleural biopsy and detecting pleural level of CA 50 \, TSA\, SF\, CEA\, chromosome analysis in differentiation of benign from malignant hydrothorax. Methods: 40 patients of tuberculous hydrothorax (group A) and 34 patients of malignant hydrothorax (group B) were taken pleural biopsy and detected the pleural level of CA 50 ?TSA?CEA?SF with radioimmunoassay, routine chromosome preparation, and compared the difference of the level of above\|mentioned markers, estimated the positive rate and specific of above\|mentioned markers. Results: The positive rate of pleural biopsy in patients with tuberculous and malignant hydrothorax were 60% and 50%. The values of CA 50 ?TSA?CEA?SF and chromosome analysis in group B were significantly higher than those in group A (P<0 001 and P<0 01). The sensitivity of using a combination of the CA 50 ?TSA?CEA?SF?chromosome analysis assays and a combination of the CA 50 ?CEA?chromosome analysis assays were increased to 88% and 76%, there was significant difference (P<0 01). The specific of combination assay of 3 markers was 95%, it was significantly higher than that of single assay (P<0 05). The specific of combination assay of 3 markers was significantly heiger than that of 5 markers (P<0 01). Conclusion: The results suggest that determination of CA 50 ?TSA?CEA?SF and chromosome analysis are better for the differentiating benign from malignant hydrothorax. The missed diagnosis rate of combination assay of 5 markers may produce a significant decrease in patients with malignant hydrothorax. CEA\, CA 50 in combination with chromosome analysis assay may be a better indicator for screening the malignant hydrothorax.\;

关 键 词：胸腔积液 良恶性鉴别 多指标联检 

分 类 号：R561[医药卫生—呼吸系统]