目的 通過(guò)檢測(cè)胸腔積液中腫瘤M2 型丙酮酸激酶( M2-PK) 水平, 探討腫瘤M2-PK 對(duì)于胸腔積液鑒別診斷的臨床應(yīng)用價(jià)值。方法 收集2006 年1 月至2008 年12 月在中山大學(xué)附屬汕頭醫(yī)院和中山大學(xué)附屬第一醫(yī)院呼吸科住院和門、急診就診的胸腔積液患者146 例, 其中惡性胸腔積液72 例( 肺癌52 例, 肺外惡性腫瘤20 例) , 良性胸腔積液74 例( 感染性胸腔積液54 例, 漏出液20例) 。將胸腔積液患者分為惡性胸腔積液組、感染性胸腔積液組和漏出液組, 其中感染性胸腔積液包括結(jié)核性胸腔積液和肺炎旁胸腔積液兩個(gè)亞組, 取第一次胸腔穿刺術(shù)所得的胸腔積液標(biāo)本, 應(yīng)用ELISA 法測(cè)定胸腔積液中腫瘤M2-PK 的濃度。結(jié)果 惡性胸腔積液中腫瘤M2-PK 濃度為( 39. 58 ±3. 15) U/mL, 顯著高于良性胸腔積液( 13. 47 ±0. 90) U/mL, 與良性胸腔積液中各亞組比較均有統(tǒng)計(jì)學(xué)意義( P lt;0. 01) 。肺癌所致惡性胸腔積液的腫瘤M2-PK 濃度與肺外惡性腫瘤胸膜轉(zhuǎn)移所致惡性
胸腔積液比較有顯著差異[ ( 44. 90 ±4. 39) U/mL 比( 27. 08 ±4. 55) U/mL, P lt; 0. 05) 。根據(jù)ROC 曲線, 取腫瘤M2-PK 濃度18. 68 U/mL為臨界值, 診斷惡性胸腔積液的敏感性為87. 6% , 特異性為86. 0%, 準(zhǔn)確性為87. 4% 。腫瘤M2-PK 和癌胚抗原( CEA) 聯(lián)合診斷惡性胸腔積液的敏感性為96. 0%, 特異性為85. 0% , 準(zhǔn)確性為91. 1% 。結(jié)論 測(cè)定胸腔積液中腫瘤M2-PK 濃度對(duì)鑒別良、惡性胸腔積液有一定價(jià)值, 與CEA 聯(lián)合診斷惡性積液時(shí)敏感性和特異性進(jìn)一步提高, 值得在臨床推廣應(yīng)用。
引用本文： 黃斌 ,謝燦茂,張盛斌,林茂煌,余天蜂. 腫瘤M2 型丙酮酸激酶在良性和惡性胸腔積液的表達(dá)及其臨床價(jià)值. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2010, 9(3): 306-309. doi: 復(fù)制
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| 4. | 張薇, 王進(jìn), 武志芳, 等. CA125 在鑒別良惡性胸腔積液中的應(yīng)用分析. 山西醫(yī)藥雜志, 2006, 35 : 430-431. |
| 5. | Eigenbrodt E, Basenau D, Holthusen S, et al. Quantification of tumor type M2 pyruvate kinase ( Tu M2-PK ) in human carcinomas.Anticancer Res, 1997, 17: 3153-3156. |
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| 7. | Hugo F, Fischer G, Eigenbrodt E. Quantitative detection of tumor M2 -PK in serum and plasma. Anticancer Res, 1999, 19: 2753-2757 . |
| 8. | Riantawan P, Sanqsayan P, Banqpattanasiri K, et al. Limited additive value of pleural fluid carcinoembryonic antigen level in malignantpleural effusion. Respiration, 2000, 67 : 24-29. |
| 9. | Porcel JM, Vives M, Esquerda A, et al. Use of a panel of tumor marker( carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosisof benign and malignant effusions. Chest, 2004 ,126: 1721 -1722 . |
- 1. Seemann MD, Beinert T, Fürst H, et al. An evaluation of the tumour markers, carcinoembryonic antigen ( CEA ) , cytokeratin marker ( CYFRA 21-1 ) and neuron-specific enolase ( NSE) in the differentiation of malignant from benign solitary pulmonary lesions.Lung Cancer, 1999, 26: 149-155 .
- 2. Okuno SH, Jett JR. Small cell lung cancer: current therapy and promising new regimens. Oncologist, 2002, 7: 234-238.
- 3. 吳廣平, 巴靜, 王恩華, 等. 檢測(cè)胸水CEA、CA125 、CA153 及CA199 對(duì)肺癌的診斷價(jià)值. 中國(guó)肺癌雜志, 2004, 7: 36-38.
- 4. 張薇, 王進(jìn), 武志芳, 等. CA125 在鑒別良惡性胸腔積液中的應(yīng)用分析. 山西醫(yī)藥雜志, 2006, 35 : 430-431.
- 5. Eigenbrodt E, Basenau D, Holthusen S, et al. Quantification of tumor type M2 pyruvate kinase ( Tu M2-PK ) in human carcinomas.Anticancer Res, 1997, 17: 3153-3156.
- 6. Oremek GM, Teigelkamp S, Kramer W, et al. The pyruvate kinase isoenzyme tumor M2 ( Tu M2-PK) as a tumor marker for renal carcinoma. Anticancer Res, 1999, 19 : 2599 -2601.
- 7. Hugo F, Fischer G, Eigenbrodt E. Quantitative detection of tumor M2 -PK in serum and plasma. Anticancer Res, 1999, 19: 2753-2757 .
- 8. Riantawan P, Sanqsayan P, Banqpattanasiri K, et al. Limited additive value of pleural fluid carcinoembryonic antigen level in malignantpleural effusion. Respiration, 2000, 67 : 24-29.
- 9. Porcel JM, Vives M, Esquerda A, et al. Use of a panel of tumor marker( carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosisof benign and malignant effusions. Chest, 2004 ,126: 1721 -1722 .