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目的:探讨6种肿瘤标志物癌胚抗原(CEA)、糖链抗原125(CA-125)、糖链抗原15-3(CA15-3)、鳞状上皮细胞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)、细胞角质素片断抗原(CYFRA21-1)在良恶性胸水辅助诊断中的价值。方法:测定76例恶性胸腔积液患者、84例良性胸腔积液患者胸水CEA、CA-125、CA15-3、SCC、NSE、CYFRA21-1的水平。结果:恶性胸腔积液患者的6种肿瘤标志物水平均明显高于良性疾病组,有显著性差异(P<0.05)。CEA、CA-125、CA15-3、SCC、NSE、CYFRA21-1对恶性胸水诊断的敏感性分别为75.0%、81.6%、43.4%、59.2%、53.9%、46.1%;特异性为84.5%、46.4%、88.1%、80.9%、83.3%、86.9%;准确性为80.0%、63.1%、66.9%、70.6%、69.4%、67.5%。与CEA单项检测比较6项指标联合检测,以任意一项阳性为阳性判断,可显著提高诊断敏感性(P<0.01),而诊断准确性无显著改变(P>0.05)。结论:CEA可作为临床鉴别良恶性胸水的首选指标。CEA、CA-125、CA15-3、SCC、NSE、CYFRA21-1联合检测可显著提高对恶性胸水的诊断阳性率。
Objective: To investigate the expression of six tumor markers, CEA, CA-125, CA15-3, SCC, Enolase (NSE), Cytokeratin fragment antigen (CYFRA21-1) in the diagnosis of benign and malignant pleural effusion. Methods: The levels of CEA, CA-125, CA15-3, SCC, NSE and CYFRA21-1 in pleural effusion were measured in 76 patients with malignant pleural effusion and 84 patients with benign pleural effusion. Results: The levels of 6 tumor markers in patients with malignant pleural effusion were significantly higher than those in benign disease group (P <0.05). The sensitivity of CEA, CA-125, CA15-3, SCC, NSE and CYFRA21-1 in the diagnosis of malignant pleural effusion were 75.0%, 81.6%, 43.4%, 59.2%, 53.9% and 46.1% 46.4%, 88.1%, 80.9%, 83.3%, 86.9%; accuracy was 80.0%, 63.1%, 66.9%, 70.6%, 69.4%, 67.5%. Compared with the single test of CEA, the combined detection of 6 indexes could be used to improve the diagnostic sensitivity (P <0.01), but no significant change in diagnostic accuracy (P> 0.05). Conclusion: CEA can be used as the first choice of clinical diagnosis of benign and malignant pleural effusion. CEA, CA-125, CA15-3, SCC, NSE, CYFRA21-1 joint detection can significantly improve the positive rate of diagnosis of malignant pleural effusion.