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目的:探讨胸水脱落细胞DNA倍体分析及胸水癌胚抗原(CEA)与血清CEA比值测定对恶性胸腔积液的诊断价值。方法:41例恶性胸腔积液患者为试验组,84例良性胸腔积液患者为对照组,抽取2组患者胸水和血液,采用全自动细胞图像分析系统对胸水脱落细胞进行DNA倍体分析,用蛋白芯片-化学发光法检测血及胸水癌胚抗原水平,计算胸水CEA与血清CEA比值;比较2种方法单独应用或联合应用时诊断恶性胸腔积液的灵敏度、特异度及youden值。结果:试验组胸水脱落细胞DNA倍体分析阳性率和胸水CEA与血清CEA比值阳性率均高于对照组(P<0.05);胸水脱落细胞DNA倍体分析对恶性胸腔积液诊断灵敏度为85.37%、特异度为66.67%、youden指数0.52,胸水CEA与血清CEA比值对恶性胸腔积液诊断灵敏度为78.05%,特异度为77.38%,youden指数0.55,2种方法比较差异无统计学意义(P>0.05);2种方法联合诊断恶性胸腔积液的灵敏度为96.79%,特异度为92.46%,youden指数0.59。结论:胸水脱落细胞DNA倍体分析联合胸水CEA与血清CEA比值测定,对鉴别良、恶性胸腔积液具有更好的诊断价值。
Objective: To investigate the value of DNA ploidy analysis of pleural fluid exfoliated cells and the diagnostic value of CEA and CEA in the diagnosis of malignant pleural effusion. Methods: Twenty-one patients with malignant pleural effusion were selected as experimental group and 84 patients with benign pleural effusion as control group. The pleural effusion and blood were extracted from two groups of patients. DNA ploidy analysis was performed on exfoliated cells of pleural effusion by using automatic cell image analysis system. The protein chip-chemiluminescence method was used to detect the levels of carcinoembryonic antigen in blood and pleural effusion, and the ratio of CEA to serum CEA was calculated. The sensitivity, specificity and youden value of malignant pleural effusion were compared between the two methods alone or in combination. Results: The positive rate of DNA ploidy analysis of pleural fluid exfoliated cells and the positive rate of CEA and serum CEA in test group were higher than those in control group (P <0.05). The DNA ploidy analysis of pleural effusion cells had a sensitivity of 85.37% , The specificity was 66.67%, youden index 0.52, the diagnostic sensitivity of pleural effusion CEA and serum CEA in malignant pleural effusion was 78.05%, specificity was 77.38%, youden index was 0.55, there was no significant difference between two methods (P> 0.05). The sensitivity of the two methods for the diagnosis of malignant pleural effusion was 96.79%, the specificity was 92.46%, the youden index was 0.59. Conclusion: DNA ploidy analysis of pleural fluid exfoliated cells combined with CEA of pleural effusion and serum CEA value has a better diagnostic value in differentiating benign and malignant pleural effusions.