胸腔积液癌胚抗原1000【癌胚抗原和C-反应蛋白在结核性和恶性胸腔积液诊断中的临床意义】
[摘要] 目的 探讨癌胚抗原（CEA）和C反应蛋白（CRP） 在结核性和恶性胸腔积液诊断中的临床意义。 方法 120例胸腔积液患者按照病因不同分为结核性胸腔积液86例和恶性胸腔积液34例，观察两组患者胸腔积液中CEA和CRP水平。 结果 CEA水平及阳性率恶性胸腔积液组明显高于结核性胸腔积液组，而CRP水平及阳性率结核性胸腔积液组明显高于恶性胸腔积液组，差异有高度统计学意义（P ＜ 0.01），并且CEA ＞ 8 μg/L诊断恶性胸腔积液的灵敏度为55.88%，特异性为100.0%，而CRP ＞6 mg/L诊断结核性胸腔积液的灵敏度为78.18%，特异性为87.18%。 结论 CRP和CEA联合监测对结核性和恶性胸腔积液鉴别诊断有较好的临床意义。
[关键词] 胸腔积液；C反应蛋白；癌胚抗原；结核性胸腔积液；恶性胸腔积液
[中图分类号] R561.3 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0087-02
Diagostic values of carcinoembryonic antigen and C-reactive protein in differentiate between tuberculosis and malignant pleural effusion
LI Jianpeng1 YANG Liping2
1.Department of Respiratory, the Third People′s Hospital of Wuzhou City, Guangxi Zhuang Autonomous Region, Wuzhou 543000, China; 2.Department of ICU, the People"s Hospital of Wuzhou City, Guangxi Zhuang Autonomous Region, Wuzhou 543000, China
[Abstract] Objective To discuss the value of carcinoembryonic antigen (CEA) and C reactive protein (CRP) in differential diagnosis of malignant pleural effusion. Methods The levels of CEA and CRP in 34 cases of neoplastic pleural effusion and 86 cases of tuberculous pleural effusion were detected and compared. Results CEA level and positive rate in pleural effusion group was significantly higher than that of malignant pleural effusion group, while the CRP level and positive rate in pleural effusion group was higher than that of tuberculosis of malignant pleural effusion group, differences were statistically significant (P 8 μg/L in the diagnosis of malignant pleural effusion sensitivity was 55.88%, specificity was 100.00%, while the CRP > 6 mg/L for diagnosis of tuberculous pleural effusion sensitivity was 78.18%, specificity was 87.18%. Conclusion CRP and CEA have important value in differential diagnosis of neoplastic pleural effusion and tuberculous pleural effusion.
[Key words] Pleural effusion; C-reactive protein; Carcinoembryonic antigen; Tuberculous hydrothorax; Malignant pleural effusion
胸腔积液（pleural effusion）是临床较为常见的一种临床症状[1]。近年来随着肺结核发病率不断升高，胸腔积液的发病率也不断增加[2]。但是肺结核导致的胸腔积液在临床上很难与恶性肿瘤导致的胸腔积液鉴别，传统的鉴别方法是通过胸腔积液中的细胞学检测来鉴别的，但当胸腔积液中肿瘤细胞少或无时，细胞学诊断的敏感性则较低，假阴性比例就会明显升高[3]，因此需找一种有效鉴别结核性胸腔积液和恶性胸腔积液的指标显得极为重要，为此本研究对120例胸腔积液患者胸水中的癌胚抗原（CEA）和C-反应蛋白（CRP）水平进行检测和分析，现报道如下：
1 对象与方法
1.1 研究对象
选择2008年1月～2012年1月在梧州市第三人民医院以及梧州市人民医院进行住院治疗的胸腔积液患者120例，所有患者均进行胸部影像学、胸膜组织活检、胸腔积液涂片以及脱落细胞学检查，最终确诊为结核性胸腔积液 86例，其中，男47例，女39例，平均年龄（56.32±13.43）岁；恶性胸腔积液 34例，男18例，女16例，平均年龄（59.45±16.34）岁。两组患者年龄、性别和临床症状比较，差异均无统计学意义（P ＞ 0.05），具有可比性。