Fujimoto Nobukazu, Gemba Kenichi, Asano Michiko, Fuchimoto Yasuko, Wada Sae, Ono Katsuichiro, Ozaki Shinji, Kishimoto Takumi
Department of Respiratory Medicine, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minamiku, Okayama 7028055, Japan.
Respir Investig. 2013 Jun;51(2):92-7. doi: 10.1016/j.resinv.2013.02.002. Epub 2013 Mar 19.
We retrospectively analyzed hyaluronic acid (HA) concentrations in pleural fluid and evaluated its utility for the differential diagnosis of malignant pleural mesothelioma (MPM).
Pleural fluid HA concentrations were measured in 334 patients, including 50, 48, 85, 18, 86, 6, and 41 patients with MPM, benign asbestos pleurisy (BAP), lung cancer (LC), other malignant conditions (OMCs), infectious pleuritis (IP), collagen disease (CD), and other conditions, respectively.
The median (range) HA concentrations in pleural fluid were 78,700 (7920-2,630,000)ng/ml in the MPM group, 35,950 (900-152,000)ng/ml in the BAP group, 19,500 (2270-120,000)ng/ml in the LC group, 14,200 (900-101,000)ng/ml in the OMC group, 23,000 (900-230,000)ng/ml in the IP group, 24,600 (9550-80,800)ng/ml in the CD group, and 8140 (900-67,800)ng/ml in the other diseases group. HA levels were significantly higher in the MPM group than in the other groups. Receiver operating characteristic (ROC) analysis revealed an area under the ROC curve value of 0.832 (95% confidence interval, 0.765-0.898) for the differential diagnosis of MPM. With a cutoff value of 100,000ng/ml, the sensitivity and specificity were 44.0 and 96.5%, respectively. In the MPM group, HA values were significantly higher for the epithelioid subtype than for the sarcomatous subtype (p=0.007), and higher in earlier stages (I and II) than in advanced stages (III and IV) (p=0.007).
A diagnosis of MPM should be strongly considered in patients with pleural fluid HA concentrations exceeding 100,000ng/ml.
我们回顾性分析了胸腔积液中的透明质酸（HA）浓度，并评估了其在恶性胸膜间皮瘤（MPM）鉴别诊断中的作用。
测量了334例患者胸腔积液中的HA浓度，其中分别有50例、48例、85例、18例、86例、6例和41例患者患有MPM、良性石棉性胸膜炎（BAP）、肺癌（LC）、其他恶性疾病（OMC）、感染性胸膜炎（IP）、胶原病（CD）和其他疾病。
MPM组胸腔积液中HA浓度的中位数（范围）为78,700（7920 - 2,630,000）ng/ml，BAP组为35,950（900 - 152,000）ng/ml，LC组为19,500（2270 - 120,000）ng/ml，OMC组为14,200（900 - 101,000）ng/ml，IP组为23,000（900 - 230,000）ng/ml，CD组为24,600（9550 - 80,800）ng/ml，其他疾病组为8140（900 - 67,800）ng/ml。MPM组的HA水平显著高于其他组。受试者工作特征（ROC）分析显示，用于MPM鉴别诊断的ROC曲线下面积值为0.832（95%置信区间，0.765 - 0.898）。截断值为100,000ng/ml时，敏感性和特异性分别为44.0%和96.5%。在MPM组中，上皮样亚型的HA值显著高于肉瘤样亚型（p = 0.007），早期（I和II期）高于晚期（III和IV期）（p = 0.007）。
胸腔积液HA浓度超过100,000ng/ml的患者应强烈考虑诊断为MPM。
