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目的探讨联合检测癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)在胸腔积液与血清中的比值对恶性胸腔积液的诊断价值。方法 79例临床已确诊的胸腔积液患者(恶性47例,结核性32例)的血清和胸腔积液采用酶免疫法进行CEA、NSE含量测定。计算CEA、NSE在胸腔积液与血清中的比值(P/S)。应用受试者工作特性曲线(ROC曲线)确定诊断恶性胸腔积液的最佳临界值,以最佳临界值为判断良恶性胸腔积液标准,计算P/S(CEA)、P/S(NSE)及联合检测两者(并联试验)的诊断敏感度、特异度、准确度及Youden指数。结果恶性组P/S(CEA)、P/S(NSE)分别较结核组高。以P/S(CEA)≥1.1、P/S(NSE)≥1.3为恶性胸腔积液界值,并联试验显示对联合检测P/S(CEA)、P/S(NSE)对诊断恶性胸腔积液的敏感度为91.49%,特异度为62.50%,准确度为79.94%,Youden指数为0.54,较单一检测P/S(CEA)或P/S(NSE)能提高诊断的敏感度、准确度及Youden指数。结论联合检测CEA、NSE在胸腔积液与血清中的比值对恶性胸腔积液的诊断有较大价值,能提高诊断敏感度,减少漏诊率,尤其适合于基层医院推广应用。
Objective To investigate the diagnostic value of combined detection of carcinoembryonic antigen (CEA) and neuron specific enolase (NSE) in pleural effusion and serum in malignant pleural effusion. Methods Serum and pleural effusion of 79 clinically diagnosed cases of pleural effusion (malignant 47 cases, tuberculous 32 cases) were determined by enzyme immunoassay. The ratio of CEA and NSE in pleural effusion to serum (P / S) was calculated. The receiver operating characteristic curve (ROC curve) was used to determine the optimal critical value for the diagnosis of malignant pleural effusion. The best critical value was used to determine the benign and malignant pleural effusion. P / S (CEA), P / S ) And combined detection of both (parallel test) diagnostic sensitivity, specificity, accuracy and Youden index. Results The malignant group P / S (CEA), P / S (NSE) were higher than the tuberculosis group. The P / S (CEA) ≥1.1, P / S (NSE) ≥1.3 malignant pleural effusion boundary value, the parallel test showed that the combination of P / S (CEA), P / S The sensitivity, accuracy and accuracy of liquid were 91.49%, 62.50%, 79.94% and Youden index were 0.54, respectively, which could improve the sensitivity and accuracy of diagnosis compared with single detection of P / S (CEA) or P / S And Youden index. Conclusion The combined detection of CEA and NSE in pleural effusion and serum ratio has great value in the diagnosis of malignant pleural effusion, which can improve the diagnostic sensitivity and reduce the misdiagnosis rate, especially suitable for the popularization and application of primary hospitals.