【摘要】 目的探讨心包积液中胸苷激酶1（TK1）、细胞角蛋白19片段（CYFRA21-1）、神经元特异性烯醇化酶（NSE）和癌胚抗原（CEA）的水平对心包积液性质的鉴别诊断价值。方法收集2015年6月至2019年1月94例恶性心包积液和221例良性心包积液患者。定量检测良、恶性心包积液中CYFRA21-1、NSE、CEA、糖类抗原199（CA199）、糖类抗原125（CA125）、甲胎蛋白（AFP）和糖类抗原153（CA153）水平;采用Logistic回归分析筛选有价值的指标并建模,以受试者工作特征（ROC）曲线评价其在鉴别心包积液性质中的价值。结果恶性心包积液组TK1、CYFRA21-1、NSE、CEA和CA199的水平明显高于良性心包积液组,差异有统计学意义（P<0.05）。筛选出TK1、CYFRA21-1、NSE和CEA建立回归模型:Logit（Y）=-0.086-3.913X_TK1+5.308X_CYFRA21-1-0.859X_NSE+0.394X_CEA。TK1、CYFRA21-1、NSE和CEA的截断值分别为1.81 pmol/L、4.11ng/ml、22.98 ng/ml和8.14 ng/ml。单项中CYFRA21-1的特异度和诊断符合率最高（分别为0.964和0.908,P<0.05）; TK1的灵敏度最高（0.830,P<0.05）; CEA的曲线下面积（AUC）最高（0.896,P<0.05）。联合检测的截断值为0.221,灵敏度、诊断符合率和AUC较单项检测明显提高（分别为0.957,0.971和0.993,P<0.05）,而特异度与单项最优的CYFRA21-1无显著差异（0.977,P>0.05）。结论心包积液中TK1、CYFRA21-1、NSE和CEA水平对心包积液性质鉴别有重要价值,四者联合检测可明显提高诊断效能。更多还原

【Abstract】 Objective To investigate the value of detection of thymidine kinase 1（ TK1）,cytokeratin-19-fragment（ CYFRA21-1）,neuron-specific enolase（ NSE） and carcinoembryonic antigen（ CEA） in the differential diagnosis of benign and malignant pericardial effusion. Methods From June 2015 to January 2019,94 patients with malignant pericardial effusion and 221 patients with benign pericardial effusion were enrolled. The levels of TK1,CYFRA21-1,NSE,CEA,carbohydrate antigen 199（ CA199）,carbohydrate antigen 125（ CA125）,alpha fetoprotein（ AFP） and carbohydrate antigen 153（ CA153） in pericardial effusion were detected quantitatively in benign and malignant pericardial effusion. A prediction model by logistic regression analysis after selecting valuable indicators from them was established. Receiver operating characteristic（ ROC） curve was performed to evaluate the value in different pericardial effusion. Results TK1,CYFRA21-1,NSE,CEA and CA199 levels in patients with malignant pericardial effusion were significantly higher than those of benign pericardial effusion（ P< 0. 05）. TK1,CYFRA21-1,NSE and CEA were selected as the valuable indicators and logistic regression model was established: Logit（ Y） =-0. 086-3. 913 X_TK1+5. 308 X_CYFRA21-1-0. 859 X_NSE+0. 394 X_CEA. The cut-off values of TK1,CYFRA21-1,NSE and CEA were 1. 81 pmol/L,4. 11 ng/ml,22. 98 ng/ml and8. 14 ng/ml,respectively. CYFRA21-1 had the highest specificity and diagnostic coincidence rate（ 0. 964 and 0. 908 respectively,P<0. 05）. The sensitivity of TK1 was the highest（ 0. 830,P< 0. 05） and CEA had the highest area under curve（ AUC）（ 0. 896,P<0. 05）. The cut-off value of combined detection was 0. 221. Sensitivity,diagnostic coincidence rate and AUC of it were significantly higher than those of single tumor marker（ 0. 957,0. 971 and 0. 993 respectively,P< 0. 05）,while specificity was not significantlydifferent from that of the optimal CYFRA21-1（ 0. 977,P> 0. 05）. Conclusion The levels of TK1,CYFRA21-1,NSE and CEA in pericardial effusion are of great value for the identification of pericardial effusion. Combined detection can significantly improve the diagnostic efficiency.更多还原