摘要
目的探讨B7－H4和癌胚抗原（CEA）联合检测鉴别诊断良、恶性胸腔积液的价值。方法收集97例胸腔积液标本，其中恶性胸腔积液55例，良性胸腔积液42例。采用酶联免疫吸附法检测B7－H4水平，采用电化学发光法检测CEA水平，采用受试者工作特征（ROC）曲线评价B7－H4、CEA和B7－H4联合CEA检测对良、恶性胸腔积液的鉴别诊断价值。结果恶性胸腔积液组和良性胸腔积液组患者的B7－H4水平分别为（60.08±35.04 ）ng/ml和（27.26±9.55）ng/ml，CEA水平分别为（41.49±37.16 ）ng/ml和（2.41±0.94）ng/ml，两组患者的B7－H4和CEA水平差异均有统计学意义（均P〈0.01）。B7－H4诊断恶性胸腔积液的ROC曲线下面积为0.884，最佳诊断临界值为37.25 ng/ml，敏感度和特异度分别为81.8%和90.5%。CEA诊断恶性胸腔积液的ROC曲线下面积为0.954，最佳诊断临界值为4.18 ng/ml，敏感度和特异度分别为87.3%和95.2%。B7－H4和CEA并联检测，即B7－H4〉37.25 ng/ml或CEA〉4.18 ng/ml时，则为恶性胸腔积液，其敏感度可提高至90.9%，特异度降低至88.1%；B7－H4和CEA串联检测，即B7－H4〉37.25 ng/ml且CEA〉4.18 ng/ml时，则为恶性胸腔积液，其敏感度降低至78.2%，特异度提高至97.6%。B7－H4和CEA联合检测时，敏感度和特异度可分别提高至90.9%和97.6%。恶性胸腔积液中B7－H4与CEA水平呈正相关（r＝0.670，P＝0.001），良性胸腔积液中B7－H4与CEA水平呈正相关（r＝0.002，P＝0.001）。结论B7－H4可鉴别诊断良、恶性胸腔积液，但诊断效能未优于CEA。B7－H4和CEA联合检测可提高诊断恶性胸腔积液的敏感度和特异度。
Objective To evaluate the value of combined detection of negative costimulatory molecule B7-H4 and earcinoembryonie antigen （CEA） in diagnosing malignant and benign pleural effusion. Methods Ninety-seven pleural effusion specimen were collected, 55 of which were diagnosed as malignant pleura1 effusion and 42 were benign pleural effusion. Enzyme-linked immunosorbent assay（ELISA） was used to examine the concentration of B7-H4 and CEA in pleural effusion. Electro-chemiluminescence immunoassay was used to detect the CEA level in pleural effusion. Receiver operating characteristic （ ROC ） curve was established to analyze and evaluate the single or combined detection of B7-H4 and CEA in diagnosing malignant and benign pleural effusion. Results The concentrations of B7-H4 and CEA in malignant pleural effusion （MPE） group were （60.08±35.04） ng/ml and （41.49±37.16） ng/ml, respectively, obviously higher than （ 27.26±9.55 ） ng/ml and （ 2.41± 0.94） ng/ml of benign pleural effusion （ BPE ） group （ both P〈0.01）. Area under curve （AUC） of B7-H4 was 0.884 in MPE groupand the diagnostic sensitivity and specificity were 81.8% and 90.5%, respectively, at the optimized cut off value of 37.25 ng/ml. Likewise, area under curve （AUC） of CEA was 0.954 and the sensitivity and specificity were 87.3% and 95.2%, respectively, at the cut off value of 4.18 ng/ml. When B7-H4 〉 37.25 ng/ml or CEA〉4.18 ng/ml, the sensitivity of diagnosis as MPE was down-regnlated to 90.9% and the specificity was elevated to 88.1%.When B7-H4 〉37.25 ng/ml and CEA〉4.18 ng/ml, the sensitivity of diagnosis as MPE was down-regulated to 78.2% and the specificity was elevated to 97.6%. The sensitivity and specificity of combined detection of B7-H4 and CEA to diagnose MPE were elevated to 90.9% and 97.6%, respectively. The level of B7-H4 in MPE and BPE were both positively correlated with CEA （r= 0.670, P= 0.001 in MPE and r= 0.002, P= 0.001 in BEP）. Conclusions B7-H4 is a potential tumor marker in diagnosing the benign and malignant pleural effusion. Although the diagnostic value of B7-H4 may not precede to CEA, the combined detection of B7-H4 and CEA can improve the diagnostic sensitivity and specificity of MPE.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2017年第7期524-527,共4页
Chinese Journal of Oncology
关键词
胸腔积液
恶性
癌胚抗原
B7-H4
诊断
敏感度
特异度
Pleural effusion, malignant
Carcinoembryonic antigen
B7-H4
Diagnosis
Sensitivity
Specifity
