Division of Pulmonology, Clinic of Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia.
Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
Biochem Med (Zagreb). 2018 Feb 15;28(1):010706. doi: 10.11613/BM.2018.010706. Epub 2018 Jan 10.
We investigated whether tumour markers carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cancer antigen 125 (CA-125), and cytokeratin 19 fragment (CYFRA 21-1) in pleural effusions and serum can be used to distinguish pleural effusion aetiology.
During the first thoracentesis, we measured pleural fluid and serum tumour marker concentrations and calculated the pleural fluid/serum ratio for patients diagnosed with pleural effusion, using electrochemiluminescence immunoassays. Receiver operating characteristic (ROC) analysis was carried out and the Hanley and McNeil method was used to test the significance of the difference between the areas under ROC curves (AUCs). In order to detect which tumour marker best discriminates between malignant and non-malignant pleural effusions and to establish the predictive value of those markers, discriminant function analysis (DFA) and logistic regression analysis were utilized.
Serum tumour markers CYFRA 21-1 and NSE as well as pleural NSE were good predictors of pleural effusion malignancy and their combined model was found statistically significant (Chi-square = 28.415, P < 0.001). Respective ROC analysis showed significant discrimination value of the combination of these three markers (AUC = 0.79).
Serum markers showed superiority to pleural fluid markers in determining pleural fluid aetiology. Serum CYFRA 21-1 and NSE concentrations as well as pleural fluid NSE values had the highest clinical value in differentiating between malignant and non-malignant pleural effusions. The combination of these three markers produced a significant model to resolve pleural effusion aetiology.
我们研究了胸腔积液和血清中的肿瘤标志物癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、癌抗原 125（CA-125）和细胞角蛋白 19 片段（CYFRA 21-1）是否可用于区分胸腔积液的病因。
在第一次胸腔穿刺时，我们使用电化学发光免疫分析法测量了胸腔积液和血清中肿瘤标志物的浓度，并计算了胸腔积液/血清比值。进行了受试者工作特征（ROC）分析，并使用 Hanley 和 McNeil 方法检验 ROC 曲线下面积（AUC）之间差异的显著性。为了检测哪种肿瘤标志物最能区分恶性和非恶性胸腔积液，并确定这些标志物的预测值，我们利用判别函数分析（DFA）和逻辑回归分析进行了分析。
血清肿瘤标志物 CYFRA 21-1 和 NSE 以及胸腔积液 NSE 是胸腔积液恶性的良好预测因子，其联合模型具有统计学意义（卡方=28.415，P<0.001）。各自的 ROC 分析显示，这三种标志物联合具有显著的鉴别价值（AUC=0.79）。
血清标志物在确定胸腔积液病因方面优于胸腔积液标志物。血清 CYFRA 21-1 和 NSE 浓度以及胸腔积液 NSE 值在区分恶性和非恶性胸腔积液方面具有最高的临床价值。这三种标志物的联合产生了一个有意义的模型，可以解决胸腔积液的病因问题。
