摘要
目的探讨血清和胸水中人附睾蛋白4(HE4)、巨噬细胞抑制细胞因子-1(MIC-1)、癌胚抗原(CEA)水平对老年人非小细胞肺癌胸腔积液的诊断价值。方法选取2018年6月-2021年12月在唐山市人民医院住院治疗的老年人非小细胞肺癌恶性胸腔积液患者60例为恶性组,肺炎伴胸腔积液患者30例为良性组,采用电化学发光法对两组患者血清和胸水中HE4、MIC-1、CEA进行检测,并计算出检测指标的胸水与血清比值。分析两组指标水平差异;采用受试者工作特征(ROC)曲线分析各指标对恶性胸腔积液的诊断价值。结果恶性组的胸水HE4(p-HE4)、血清HE4(s-HE4)、p-HE4/s-HE4、胸水CEA(p-CEA)、血清CEA(s-CEA)、p-CEA/s-CEA检测水平明显高于良性组,差异均有统计学意义(Z=-5.808、-2.314、-5.556、-4.680、-3.194、-5.071,P均<0.001),但是两组胸水MIC-1(p-MIC-1)、血清MIC-1(s-MIC-1)、p-MIC-1/s-MIC-1水平差异无统计学意义(Z=-0.540、-0.895、-0.052,P=0.589、0.371、0.959)。胸水HE4 ROC曲线下面积最大,具有较高的诊断价值;当胸水HE4水平在551.15 pmol/L时诊断的敏感性为83.3%,特异性为90.0%。分析单项检测中诊断意义较高的胸水HE4,2项联合检测诊断意义较高的胸水HE4+胸水CEA,3项联合检测诊断意义较高的胸水HE4+p-HE4/s-HE4+胸水CEA及4项联合检测胸水HE4+p-HE4/s-HE4+胸水CEA+血清CEA,结果发现各项检测的ROC曲线下面积比较差异无统计学意义(P>0.05),但3项联合检测的敏感性、特异性较高。结论在鉴别诊断老年人非小细胞肺癌胸腔积液时,胸水HE4具有较高的诊断价值,胸水HE4+p-HE4/s-HE4+胸水CEA3项联合检测的敏感性、特异性较高。
Objective To investigate the diagnostic value of human epididymis protein 4(HE4),macrophage inhibitory cytokine-1(MIC-1),and carcinoembryonic antigen(CEA)in serum and pleural fluid for the diagnosis of non-small cell lung cancer pleural effusion in the elderly.Methods Sixty elderly patients with malignant pleural effusion of non-small cell lung cancer diagnosed in the Tangshan People's Hospital were selected as the malignant group and 30 patients with pneumonia with pleural effusion were selected as the benign group.HE4,MIC-1 and CEA in serum and pleural fluid of the two groups were detected by electrochemiluminescence method,and the pleural fluid to serum ratio of the detected indexes was calculated.The differences in the levels of the nine indexes between the two groups were analyzed;the receiver operating characteristic(ROC)working curve was used to analyze the diagnostic value of each index for malignant pleural effusion.Results The detection levels of pleural fluid HE4(p-HE4),serum HE4(s-HE4),p-HE4/s-HE4,pleural fluid CEA(p-CEA),serum CEA(s-CEA),p-CEA/s-CEA were significantly higher in the malignant group than those in the benign group,and the differences were all statistically significant(Z=-5.808,-2.314,-5.556,-4.680,-3.194,-5.071,all P<0.001),but the differences of pleural fluid MIC-1(p-MIC-1),serum MIC-1(s-MIC-1)and p-MIC-1/s-MIC-1 were not statistically significant between the two groups(Z=-0.540,-0.895,-0.052,P=0.589,0.371,0.959).The largest area under the ROC curve of pleural fluid HE4 had a high diagnostic value;the sensitivity of diagnosis was 83.3%and the specificity was 90.0%when the level of pleural fluid HE4 was 551.15 pmol/L.The diagnostic significance of pleural fluid HE4 in the single test,the diagnostic significance of pleural fluid HE4+pleural fluid CEA in the two combined tests,and the diagnostic significance of pleural fluid HE4+p-HE4/s-HE4+pleural fluid CEA in the three combined tests,and four combined tests of pleural fluid HE4+p-HE4/s-HE4+pleural fluid CEA+serum CEA were analyzed by Z-test,and no statistically significant differences were found in the comparison of the area under the ROC curve for each test(P>0.05).However,the sensitivity of the three combined assays was higher and with higher specificity.Conclusion In the differential diagnosis of non-small cell lung cancer pleural effusion in the elderly,pleural fluid HE4 had a high diagnostic value,and the sensitivity and specificity of the pleural fluid HE4+p-HE4/s-HE4+pleural fluid CEA combined tests were high.
作者
张玉敏
韩素桂
赵洪焕
张晓茹
李玉柱
ZHANG Yumin;HAN Sugui;ZHAO Honghuan;ZHANG Xiaoru;LI Yuzhu(Department of Clinical Laboratory,Tangshan People's Hospital,Tangshan,Hebei 063000,China;Nuclear Medicine Laboratory,Tangshan People's Hospital,Tangshan,Hebei 063000,China;Department of Radiology,Tangshan People's Hospital,Tangshan,Hebei 063000,China)
出处
《热带医学杂志》
CAS
2023年第8期1080-1083,共4页
Journal of Tropical Medicine
基金
2022年度河北省医学科学研究重点课题(20220218)
2020年度河北省医学科学研究重点课题(20201538)
2019年唐山市科学技术研究与发展计划项目创新团队(19130202C)
