Kuralay F, Tokgöz Z, Cömlekci A
Department of Biochemistry, Dokuz Eylül University School of Medicine, 35340, Balçova, Izmir, Turkey.
Clin Chim Acta. 2000 Oct;300(1-2):43-55. doi: 10.1016/s0009-8981(00)00302-8.
Pleural effusion is a common diagnostic problem. The analysis of serum and body fluids for tumor markers has been intensively applied to clinical diagnosis. The aim of the present study was to determine the usefulness of simultaneous quantification of carbohydrate antigen 19.9, carbohydrate antigen 125, neuron specific enolase, mucinous-carcinoma-associated antigen, and ferritin in samples of pleural fluids in the malign pleural effusion and its differentiation from benign effusions. A total of 61 pleural effusions were collected from the patients, who were subjected either to simple needle aspiration or to tube drainage for the diagnosis of pleural effusion. Tumor markers were determined in benign patient groups with nonspecific pleurisy, tuberculous pleurisy, empyema, congestive heart failure and in malignancy groups consisting of adenocarcinoma, small cell lung carcinoma, mesothelioma, epidermoid lung cancer. The tumor markers CA-19.9, CA-125, NSE, and ferritin levels were quantified by the sandwich assay using the streptavidin technology of ELISA in an ES-300 Boehringer-Mannheim analyser. MCA was measured by employing a two-side solid phase EIA method. MCA measurements were done by the Cobas-Core. For all patients, the effusions correctly or incorrectly identified by the different procedures as being malignant or nonmalignant are defined as true positive, false positive, true negative, and false negative, the term 'positive' referring to histologically proven malignant pleural effusion while nonmalignant effusions are referred to as 'negative'. Therefore, sensitivity, specificity, positive predictive value, and negative predictive value were defined as diagnostic parameters. The cut-off values calculated were 352 U/ml for CA-125, 54 U/ml for CA-19.9, 555 for ferritin, 11.1 for MCA and 8.7 for NSE. In our study, the highest sensitivity is found to be MCA with 100%; specificity, CA-19.9 with 97%; PPV, CA-19.9 and MCA with 95% and NPV, MCA with 100%. Our data imply that the co-measurement of MCA+CA-19.9+CA-125 levels may further improve their diagnostic value in malignant pleural effusion compared with that of each tumour marker alone and may be useful in distinguishing malignant from benign pleural effusions.
胸腔积液是一个常见的诊断问题。血清和体液肿瘤标志物分析已广泛应用于临床诊断。本研究的目的是确定同时定量检测胸腔积液样本中的糖类抗原19.9、糖类抗原125、神经元特异性烯醇化酶、黏液性癌相关抗原和铁蛋白在恶性胸腔积液中的作用及其与良性胸腔积液的鉴别。共收集了61例患者的胸腔积液，这些患者接受了单纯针吸或置管引流以诊断胸腔积液。在患有非特异性胸膜炎、结核性胸膜炎、脓胸、充血性心力衰竭的良性患者组以及由腺癌、小细胞肺癌、间皮瘤、肺鳞癌组成的恶性肿瘤组中测定肿瘤标志物。肿瘤标志物CA - 19.9、CA - 125、NSE和铁蛋白水平采用酶联免疫吸附测定（ELISA）的链霉亲和素技术在ES - 300勃林格殷格翰分析仪上通过夹心测定法进行定量。MCA采用双侧固相酶免疫分析法进行测定。MCA测定由Cobas - Core完成。对于所有患者，不同程序正确或错误识别为恶性或非恶性的胸腔积液被定义为真阳性、假阳性、真阴性和假阴性，术语“阳性”指经组织学证实的恶性胸腔积液，而非恶性胸腔积液称为“阴性”。因此，敏感性、特异性、阳性预测值和阴性预测值被定义为诊断参数。计算出的临界值为：CA - 125为352 U/ml，CA - 19.9为54 U/ml，铁蛋白为555，MCA为11.1，NSE为8.7。在我们的研究中，发现敏感性最高的是MCA，为100%；特异性最高的是CA - 19.9，为97%；阳性预测值最高的是CA - 19.9和MCA，为95%，阴性预测值最高的是MCA，为100%。我们的数据表明，与单独检测每种肿瘤标志物相比，联合检测MCA + CA - 19.9 + CA - 125水平可能会进一步提高它们在恶性胸腔积液中的诊断价值，并且可能有助于区分恶性和良性胸腔积液。
