Elsammak Mohamed Y, Attia Adel, Hassan Hoda A, Zaytoun Taysser M, Shorman Mahmoud, Suleman Moosa
Department of Chemical Pathology, King Fahad Specialist Hospital Dammam, Dammam, 31444, Saudi Arabia.
Tumour Biol. 2012 Oct;33(5):1701-7. doi: 10.1007/s13277-012-0427-y. Epub 2012 Jun 9.
Pleural effusion is a commonly encountered problem in clinical practice, and pleural fluid analysis is usually the first step towards identifying the underlying etiology. Numerous studies have been published analyzing the potential utility of measuring biomarkers in pleural fluid as possible indicators of a malignant effusion; however, there are no studies that have examined the presence of human epididymis 4 (HE4) in pleural effusions. The aims of this study were to assess pleural effusion and serum concentrations of HE4 in patients with different types of pleural effusions and to evaluate the diagnostic performance of HE4 in detecting malignant pleural effusion. A prospective cohort study was carried out of 88 consecutive patients presenting with pleural effusions. The patients were divided into three groups: 22 patients with transudative effusions, 32 patients with non-malignant exudative effusions, and 34 patients with malignant pleural effusions. Blood and pleural fluid HE4 levels were measured using immunoassay. Both serum HE4 levels and pleural effusion HE4 levels were significantly higher in patients with malignant effusions than in patients with transudative or non-malignant exudative effusions. A pleural fluid HE4 cutoff value of 1,675 pmol/L was found to predict malignant pleural effusions with a diagnostic sensitivity of 85.3 % and specificity of 90.7 %. The current study reports a novel finding of increased serum and pleural fluid HE4 levels in patients with malignant effusions compared to non-malignant effusions. This finding has the potential to strengthen the diagnostic performance of tumor markers in detecting malignant pleural effusions.
胸腔积液是临床实践中常见的问题，胸腔积液分析通常是确定潜在病因的第一步。已经发表了许多研究，分析了测量胸腔积液中生物标志物作为恶性胸腔积液可能指标的潜在效用；然而，尚无研究检测胸腔积液中人类附睾蛋白4（HE4）的存在情况。本研究的目的是评估不同类型胸腔积液患者胸腔积液和血清中HE4的浓度，并评估HE4在检测恶性胸腔积液中的诊断性能。对88例连续出现胸腔积液的患者进行了一项前瞻性队列研究。患者分为三组：22例漏出液患者、32例非恶性渗出液患者和34例恶性胸腔积液患者。使用免疫测定法测量血液和胸腔积液中的HE4水平。恶性胸腔积液患者的血清HE4水平和胸腔积液HE4水平均显著高于漏出液或非恶性渗出液患者。发现胸腔积液HE4临界值为1675 pmol/L时，预测恶性胸腔积液的诊断敏感性为85.3%，特异性为90.7%。本研究报告了一项新发现，即与非恶性胸腔积液患者相比，恶性胸腔积液患者的血清和胸腔积液HE4水平升高。这一发现有可能增强肿瘤标志物在检测恶性胸腔积液中的诊断性能。
