[胸水肿瘤标志物系列在胸腔积液鉴别诊断中的价值]

Liu Yun-qiu, Zhang Hui-li, Gao Wen-jing, Lan Xuan, Yuan Bao-jun, Zou Ji-min

The Affiliated Kailuan Hospital of Huabei Coal Medical School, Tangshan 063000, Hebei, China.

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2008 Jan;26(1):34-8.

OBJECTIVE

To investigate the clinical value of pleural effusion lung ProGRP, neuron specific enolase (NSE), cytokeratin fragment 19 (CYFRA21-1), carcino-embryonic antigen (CEA), carbohydrate antigen 153 (CA153), carbohydrate antigen 19 - 9 (CA19-9) in differential diagnosis and histological typing of malignant pleural effusion caused by lung cancer.

METHODS

All the 171 patients with malignant hydrothorax caused by lung cancer were from coal-mine area of Kailuan. They were divided into the small cell lung cancer (SCLC) group (n = 39), the adenocarcinoma group (n = 99) and the squamous cell carcinoma group (n = 37). The patients with benign pleural effusion served as the controls (n = 30). The diagnostic value of pleural effusion ProGRP, NSE, CYFRA21-1, CEA, CA153 and CA19-9 was compared for each group.

RESULTS

Youden index and the accurate rate of pleural effusion ProGRP + NSE (sequence test) were the highest in the diagnosis of malignant hydrothorax caused by SCLC. CEA + CA153 + CA19-9 (sequence test) was the highest in the diagnosis of malignant hydrothorax caused by adenocarcinoma. CYFRA21-1 + CEA + CA153 (on parallel test) were the highest in the diagnosis of malignant hydrothorax caused by squamous cell carcinoma. The Yonden index and the accurate rate were the highest by the single detection of CYFRA21 (0.5514 and 0.6878), and by the combined detection of ProGRP + CYFRA21-1 + CEA (on parallel test) (0.7029 and 0.8878).

CONCLUSION

The first pleural effusion tumor markers of malignant hydrothorax caused by the SCLC, adenocarcinoma of lung, and lung squamous cell carcinoma are ProGRP, CEA and CYFRA21-1, respectively. The best combinations of pleural effusion tumor marker in diagnosis of malignant hydrothorax caused by the SCLC, adenocarcinoma of lung, lung squamous cell carcinoma and lung cancer are the combined detection of ProGRP + NSE (sequence test), combined detection of CEA + CA153 + CA19-9 (sequence test), the combined detection of CYFRA21-1 + CEA + CA153 (on parallel test) and ProGRP + CYFRA21-1 + CEA (on parallel test), respectively.

目的

探讨胸腔积液肺胃泌素释放肽前体（ProGRP）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21-1）、癌胚抗原（CEA）、糖类抗原153（CA153）、糖类抗原19-9（CA19-9）在肺癌所致恶性胸腔积液鉴别诊断及组织学分型中的临床价值。

方法

171例肺癌所致恶性胸腔积液患者均来自开滦煤矿区。分为小细胞肺癌（SCLC）组（n = 39）、腺癌组（n = 99）和鳞癌组（n = 37）。良性胸腔积液患者作为对照组（n = 30）。比较各组胸腔积液ProGRP、NSE、CYFRA21-1、CEA、CA153和CA19-9的诊断价值。

结果

ProGRP+NSE（序贯试验）在SCLC所致恶性胸腔积液诊断中的约登指数和准确率最高。CEA+CA153+CA19-9（序贯试验）在腺癌所致恶性胸腔积液诊断中最高。CYFRA21-1+CEA+CA153（并联试验）在鳞癌所致恶性胸腔积液诊断中最高。单项检测CYFRA21时约登指数和准确率最高（分别为0.5514和0.6878），ProGRP+CYFRA21-1+CEA（并联试验）联合检测时约登指数和准确率最高（分别为0.7029和0.8878）。

结论

SCLC、肺腺癌和肺鳞癌所致恶性胸腔积液的首要肿瘤标志物分别为ProGRP、CEA和CYFRA21-1。SCLC、肺腺癌、肺鳞癌及肺癌所致恶性胸腔积液诊断中最佳的肿瘤标志物组合分别为ProGRP+NSE联合检测（序贯试验）、CEA+CA153+CA19-9联合检测（序贯试验）、CYFRA21-1+CEA+CA153联合检测（并联试验）和ProGRP+CYFRA21-1+CEA联合检测（并联试验）。