改良胸膜活检术联合生物标志物等对不明原因胸腔积液的诊断价值

发布时间：2018-07-18 07:21

【摘要】：目的探讨改良胸膜活检术联合生物标志物、细胞学检查在不明原因胸腔积液中的诊断价值。方法对216例胸腔积液患者的临床资料进行回顾性分析,其中结核性胸腔积液(结核组)106例,恶性胸腔积液110例(恶性组)。所有患者均行改良胸膜活检术检查,胸腔积液细胞学检查,胸腔积液腺苷脱氨酶(ADA)、癌胚抗原(CEA)及乳酸脱氢酶(LDH)检测以及血CEA检测。统计胸膜活检术的确诊率,比较两组胸腔积液的ADA、CEA、LDH以及血CEA、胸腔积液CEA/血CEA水平。结果 216例患者共进行了241次胸膜活检穿刺,首次穿刺取材成功率94.9%(205/216),首次穿刺成功的胸膜活检材料病理结果有诊断价值的占58.8%(127/216),总确诊率65.3%(141/216),不良反应发生率为5.8%(14/241)。结核组细胞学检查肿瘤细胞阳性0例,恶性组细胞学检查肿瘤细胞阳性率54.5%(60/110);恶性组中胸腔积液CEA、LDH、血CEA及胸腔积液CEA/血CEA水平及阳性率均显著高于结核组,而胸腔积液ADA水平以及阳性率显著低于结核组,差异均有统计学意义(P0.01)。结论改良胸膜活检术、胸腔积液细胞学、胸腔积液生物标志物在单独辅助诊断胸腔积液时均具有一定的局限性,临床上可联合多种指标明确胸腔积液病因,指导治疗。
[Abstract]:Objective to evaluate the diagnostic value of modified pleural biopsy combined with biomarkers and cytology in pleural effusion of unknown origin. Methods the clinical data of 216 cases of pleural effusion were analyzed retrospectively, including 106 cases of tuberculous pleural effusion (tuberculosis group) and 110 cases of malignant pleural effusion (malignant group). All patients were examined by modified pleural biopsy, pleural effusion cytology, adenosine deaminase (ADA), carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH) and serum CEA. The diagnostic rate of pleural biopsy was analyzed and the levels of ADAA CEA LDH blood CEA and CEA / CEA in pleural effusion were compared between the two groups. Results 241 pleural biopsies were performed in 216 patients. The successful rate of the first puncture was 94.9% (205 / 216). The diagnostic value of the first successful pleural biopsy materials was 58.8% (127 / 216). The total diagnosis rate was 65.3% (141216), and the incidence of adverse reactions was 5.8% (14 / 241). The positive rate of tumor cells was 54.5% (60 / 110) in malignant group, LDH in pleural effusion, CEA in serum and CEA / CEA / CEA in pleural effusion in malignant group were significantly higher than those in tuberculosis group. The level and positive rate of ADA in pleural effusion were significantly lower than that in tuberculosis group (P0.01). Conclusion improved pleural biopsy, pleural effusion cytology and pleural effusion biomarkers have some limitations in the diagnosis of pleural effusion alone.
【作者单位】：四川省广安市人民医院检验科;四川省广安市人民医院胸外科;
【分类号】：R561.3

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