North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
Eur Respir J. 2013 Jan;41(1):18-24. doi: 10.1183/09031936.00148211. Epub 2012 Jul 12.
Mesothelin has been proposed as a useful tool in the diagnosis of malignant pleural mesothelioma (MPM). We aimed to examine its diagnostic utility and the impact of renal impairment on results. We prospectively recruited 230 patients with new undiagnosed pleural effusions, testing serum (n=216) and pleural fluid (n=206) mesothelin (by ELISA) during the initial consultation. 28 (12%) out of 230 patients had MPM. Serum mesothelin gave sensitivity 59.3%, specificity 64.7%, negative predictive value (NPV) 91.2%, positive predictive value (PPV) 20.5%, and pleural fluid sensitivity 72.0%, specificity 87.5%, NPV 95.5%, PPV 46.2% for distinguishing effusions due to MPM. In a matched comparison, diagnostic characteristics of pleural fluid mesothelin were superior to serum (p=0.0001). Serum mesothelin levels in patients without MPM were higher in patients with renal impairment (p=0.007) while pleural fluid levels were unaffected. 19 (54%) out of 35 patients with a benign pleural effusion and an estimated glomerular filtration rate ≤ 59 mL · min(-1) had a false-positive serum mesothelin result. The diagnostic accuracy of pleural fluid mesothelin is superior to that of serum and is unaffected by renal function. In patients with a low pre-test probability of mesothelioma, a negative mesothelin test could be reassuring, because of its high NPV. Routine use of mesothelin testing in undiagnosed pleural effusions at presentation appears to be unhelpful.
间皮素已被提议作为诊断恶性胸膜间皮瘤（MPM）的有用工具。我们旨在检查其诊断效用以及肾功能损害对结果的影响。我们前瞻性招募了 230 名新诊断的胸腔积液患者，在初次就诊时检测血清（n=216）和胸腔积液（n=206）间皮素（通过 ELISA）。230 名患者中有 28 名（12%）患有 MPM。血清间皮素的敏感性为 59.3%，特异性为 64.7%，阴性预测值（NPV）为 91.2%，阳性预测值（PPV）为 20.5%，胸腔积液的敏感性为 72.0%，特异性为 87.5%，NPV 为 95.5%，PPV 为 46.2%，用于区分 MPM 引起的胸腔积液。在匹配比较中，胸腔积液间皮素的诊断特征优于血清（p=0.0001）。无 MPM 的患者中，血清间皮素水平在肾功能不全患者中更高（p=0.007），而胸腔积液水平不受影响。35 名良性胸腔积液且估算肾小球滤过率≤59 mL·min(-1)的患者中，有 19 名（54%）血清间皮素检测结果为假阳性。胸腔积液间皮素的诊断准确性优于血清，且不受肾功能影响。在间皮瘤的低术前概率患者中，由于其高 NPV，阴性间皮素检测可能令人放心。在初次出现未确诊的胸腔积液时，常规进行间皮素检测似乎没有帮助。
