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目的依据病理学及细胞学检查结果评价胸腔积液中肿瘤标志物CA125、CA153、CA199、CEA在良恶性胸腔积液鉴别诊断中的价值。方法选取52例恶性胸腔积液患者和36例良性胸腔积液患者,恶性胸腔积液患者均有阳性病理学结果 ,检测患者血清和胸水中CA125、CA153、CA199、CEA水平,并以病理学结果为金标准评价其鉴别诊断价值。结果恶性胸腔积液组患者胸水中的CA125、CA153、CEA水平明显高于血清(P<0.001),良性胸腔积液组患者胸水中的CA125、CA153、CA199、CEA水平明显低于血清(P<0.05)。单纯检测CA125的敏感度高,尤其是胸水中的CA125,相反单独检测胸水中的CA153、CA199、CEA的特异度高。联合检测CA125+CA153、CA125+CA199、CA125+CEA敏感度及特异度均有提高,其中以CA125+CA153联合检测的Kappa值为0.707(P<0.001)。结论单独检测胸水中肿瘤标志物CA125、CA153、CA199、CEA的敏感度和特异度差别较大;CA125与CA153、CA199、CEA联合检测可产生最大的互补作用,更有助于良恶性胸腔积液的鉴别诊断。
Objective To evaluate the value of tumor markers CA125, CA153, CA199 and CEA in the differential diagnosis of benign and malignant pleural effusion based on the pathological and cytological findings. Methods Fifty-two patients with malignant pleural effusion and 36 patients with benign pleural effusion were enrolled in this study. All patients with malignant pleural effusion had positive pathological results. The levels of CA125, CA153, CA199 and CEA in serum and pleural effusion were measured. The pathological results Gold standard for the differential diagnosis value. Results The levels of CA125, CA153 and CEA in pleural effusion in patients with malignant hydrothorax were significantly higher than those in serum (P <0.001). The levels of CA125, CA153, CA199 and CEA in pleural effusion in patients with benign pleural effusion were significantly lower than those in serum (P < 0.05). Simple detection of CA125 high sensitivity, especially in pleural effusion CA125, on the contrary, the separate detection of pleural effusion CA153, CA199, CEA high specificity. The sensitivity and specificity of combined detection of CA125 + CA153, CA125 + CA199, CA125 + CEA were all improved. The Kappa value of CA125 + CA153 was 0.707 (P <0.001). Conclusions The sensitivity and specificity of tumor markers CA125, CA153, CA199 and CEA in pleural effusions are quite different. The combined detection of CA125, CA153, CA199 and CEA can produce the greatest complementarity and is more helpful for the diagnosis of benign and malignant pleural effusions The differential diagnosis.