标题：结核性脑膜炎合并胸腔积液患者血清CA125检测的临床价值

      作者：刘晓敏 1，陈银河 2，余良辰 3，单武林 4    1.中国科学技术大学附属第一医院西区(安徽省肿瘤医院)急诊内科，安徽 合肥 230031；2.中国科学技术大学医院外科，安徽 合肥 230031；3.安徽医科大学第二临床医学院，安徽 合肥 230031；4.中国科学技术大学附属第一医院西区(安徽省肿瘤医院)检验科，安徽 合肥 230031

      卷次： 2020年31卷22期

      【摘要】 目的 探讨血清糖类抗原125 (CA125)检测对结核性脑膜炎(TBM)合并胸腔积液患者的临床诊断价值。方法 选取2000年1月至2019年12月中国科学技术大学附属第一医院收治的TBM患者133例[不合并胸腔积液患者81例(A组)，合并胸腔积液患者52例(B组)]、脏器脓肿患者231例(C组)和体检中心健康体检者457例(D组)。比较四组受检者血清生化中的营养指标[包括总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB)、前白蛋白(PA)]和血清CA125水平。营养指标(TP、ALB、GLB)采用方差分析、PA和血清CA125采用Mann-Whitney U检验进行分析。B组患者血清CA125水平采用受试者工作特征曲线(ROC)分析，并计算曲线下面积(AUC)、灵敏度、特异度、约登指数和最佳临界值。结果 四组受检者的TP、ALB、GLB、PA指标比较差异均有统计学意义(P<0.05)，其中A组与D组、B组与D组、C组与D组两两比较差异均有统计学意义(P<0.05)；A组、B组、C组、D组受检者的CA125水平分别为13.15 (8.26，21.90) U/mL、62.59 (45.23，85.35) U/mL、15.33 (10.44，26.65) U/mL、12.29 (9.13，17.51) U/mL，差异有统计学意义(P<0.05)，其中A组与B组、B组与C组、B组与D组两两比较差异均有统计学意义(P<0.05)；B组CA125指标的AUC为0.977 (95%CI：0.968~0.987，P<0.05)，敏感度为96.20%，特异度为95.80%，约登指数为0.920，最佳临界值为38.06 U/mL。结论 血清CA125可作为TBM合并胸腔积液的诊断检测指标。
      【关键词】 结核性脑膜炎；胸腔积液；糖类抗原125；诊断
      【中图分类号】 R529.3 【文献标识码】 A 【文章编号】 1003—6350（2020）22—2902—04

Clinical application value of serum CA125 in the diagnosis of tuberculous meningitis complicated with pleuraleffusion.
LIU Xiao-min 1, CHEN Yin-he 2, YU Liang-chen 3, SHAN Wu-lin 4. 1. Department of Emergency Medicine, AnhuiProvincial Tumor Hospital/West District, the First Affiliated Hospital of University of Science and Technology of China, Hefei230031, Anhui, CHINA; 2. Department of Surgery, Hospital of University of Science and Technology of China, Hefei 230031,Anhui, CHINA; 3. The Second Clinical Medical College of Anhui Medical University, Hefei 230031, Anhui, CHINA; 4.Department of Clinical Laboratory, Anhui Provincial Tumor Hospital/West District, the First Affiliated Hospital of Universityof Science and Technology of China, Hefei 230031, Anhui, CHINA
【Abstract】 Objective To evaluate the diagnostic value of serum carbohydrate antigen 125 (CA125) in patientsof tuberculous meningitis (TBM) complicated with pleural effusion. Methods A total of 133 patients diagnosed withTBM (81 patients without pleural effusion as group A, 52 patients with pleural effusion as group B), 231 patients diag-nosed with abscess (group C), and 457 healthy controls (group D) were collected from the First Affiliated Hospital ofUniversity of Science and Technology of China between January 2000 and December 2019. The nutrition indexes suchas total protein (TP), albumin (ALB), globulin (GLB), and pre-albumin (PA) in serum biochemical test and serumCA125 were compared among the four groups. Analysis of variance and Mann-Whitney U test was used for inter-groupcomparison of nutrition indexes (TP, ALB, GLB and PA) and CA125 levels, respectively. The receiver operating charac-teristic (ROC) curve of CA125 in group B were established, and area under the ROC curve (AUC), sensitivity, specifici-ty, Youden index, and cut-off value were analyzed. Results There were statistically significant differences in nutritionindexes (TP, ALB, GLB, and PA) among the four groups (P<0.05), particularly between group A and group D, group B and groupD, group C and group D (P<0.05). The serum CA125 levels of group A, B, C, and D were 13.15 (8.26, 21.90) U/mL, 62.59(45.23, 85.35) U/mL, 15.33 (10.44, 26.65) U/mL, and 12.29 (9.13, 17.51) U/mL, respectively, and there were statisticallysignificant differences among the four groups (P<0.05), particularly between group A and B, group B and group C, andgroup B and group D (P<0.05). The area under the ROC curve, sensitivity, specificity, Youden index, and the best cut-offvalue of CA125 in group B were 0.977 (95%CI: 0.968-0.987, P<0.05), 96.20%, 95.80%, 0.920, and 38.06 U/mL, respec-tively. Conclusion Serum CA125 can be used as a diagnostic and detection test for TBM with pleural effusion.
      【Key words】 Tuberculous meningitis; Pleural effusion; Carbohydrate antigen 125; Diagnosis