【摘要】 目的:探讨液基细胞学、肿瘤标志物和DNA倍体分析单独和联合在良恶性胸腹水诊断中的鉴别价值。方法:收集312例同时做过胸腹水液基细胞学检查、DNA倍体分析和血清肿瘤标志物检测的病例，且所有病例都有组织病理诊断结果，对这些指标及人口统计学特征进行分析；基于液基细胞学、肿瘤标志物、DNA倍体分析单独及其组合的诊断，通过Logistic回归建立组合模型，并通过ROC曲线下面积(AUC)进行比较，以及计算其对应的敏感度(SE)、特异度(SP)、阳性预测值(PPV)和阴性预测值(NPV)。结果:以组织病理诊断结果为金标准，液基细胞学、肿瘤标志物和DNA倍体分析的AUC值分别是0.702、 0.512、0.776;模型1(液基细胞学联合肿瘤标志物)AUC值为0.722,SE为49.8%,SP为90.6%,PPV为79.5%,NPV为24.5%;模型2(液基细胞学联合DNA倍体分析)AUC值为0.783,SE为68.7%,SP为83.00%,PPV为95.2%,NPV为35.2%;模型3(模型2联合肿瘤标志物)AUC值0.776,SE为58.7%,SP为88.7%,PPV为85.3%,NPV为29.8%;模型2表现出对良恶性胸腹水最高的诊断效率，液基细胞学和DNA倍体分析组合的AUC值高于液基细胞学(P<0.000 1)和DNA倍体分析(P=0.399 8)。结论:DNA倍体分析的诊断价值高于液基细胞学和传统肿瘤标志物；DNA倍体分析对液基细胞学在良恶性胸腹水的诊断中具有支持价值，提供了一种鉴别良恶性胸腹水的可靠模式。更多还原

【Abstract】 Objective:To explore the differential value of liquid-based cytology, tumor marker and DNA ploidy analysis alone and in combination in the diagnosis of benign and malignant pleural effusion and ascities.Methods:312 cases with pleural effusion and ascities fluid-based cytology examination, DNA ploidy analysis and serum tumor marker detection, and the histopathological diagnosis results of all cases were collected, and analyzed these indicators and demographic characteristics.Based on fluid-based cytology, tumor markers, DNA ploidy analysis alone and its combination, the combined model was established by Logistic regression, compared by the area under the ROC curve(AUC),sensitivity(SE),specificity(SP),positive predictive value(PPV) and negative predictive value(NPV).Results:With the histopathological diagnostic results as the gold standard, the AUC of liquid-based cytology, tumor markers, and DNA ploidy analysis were 0.702,0.512,and 0.776,respectively.The AUC of Model 1(fluid-based cytology combined with tumor markers) was 0.722,the SE was 49.8%,the SP was 90.6%,the PPV was 79.5%,the NPV was 24.5%.For Model 2(fluid-based cytology combined with DNA ploidy analysis),the AUC was 0.783,the SE was 68.7%,the SP was 83.00%,the PPV was 95.2%,the NPV was 35.2%.For Model 3(Model 2 combined with tumor markers),the AUC was 0.776,the SE was 58.7%,the SP was 88.7%,the PPV was 85.3%,the NPV was 29.8%.Model 2 showed the highest diagnostic efficiency for benign and malignant pleural effusion and ascities.The AUC of the combination of liquid-based cytology and DNA ploidy analysis was higher than that of liquid-based cytology(P<0.000 1) and DNA ploidy analysis(P=0.399 8). Conclusion:The diagnostic value of DNA ploidy analysis is higher than that of liquid-based cytology and traditional tumor markers. DNA ploidy analysis is of support value for liquid-based cytology in the diagnosis of benign and malignant pleural effusion and ascities,and provides a reliable model for distinguishing benign and malignant pleural effusion and ascities.更多还原