| Background and objective:Pleural effusion is a common clinical syndrome,and 6.60 millions of cases are reported domestically every year.The most common cause of the disease is tuberculosis,and the second is tumor.The prognosis of tuberculous pleural effusion is better,can healing well.The morbidity rate of malignant pleural effusion is higher,it can result in the functional of respiration and circulation failure,hypoproteinemia,threatting to life even if you can't treat in time,.The differential diagnosis of the two is of major importance for treatment and prognosis.Currently,there is still about 20～30%cases which is unable to make clear of the property of pleural effusion through routine detection,bacteriology and cytological examination.Thus,it is of significance to find appropriate methods for differential diagnosis.Newbom vessels are the primary requirement for tumor genesis,invasion and metastasis.VEGF(Vascular endothelial growth factor) is currently deemed as the most sensitive and specific factors for promoting vessel growth in tumor,which is a key factor for formation of pleural effusion and directly correlated with pleura metastasis of tumor.Apoptosis plays an important role in physiological functions such as growth and development of organic body,cell differentiation and clearance.The inhibition of apoptosis participates in the whole pathological mechanism of tumor origin.Fas/FasL can work as the most important membrane protein molecules of siganal pathway which directly trigger the apoptosis procedure.The binding of Fas protein with its ligand(FasL) can trigger apoptosis mediated by Fas.sFas is Fas protein without membrane spanning region,which exists in plasma and humor in soluble form.sFas can blockade the cell apoptosis by competing with Fas to combine with FasL.Many research which have completed indicated that sFas concerned with tumor and malignant pleural effusion.CEA(carcinoembryonic antigen),firstly found in alimentary tract with the molecular weight of 150～200KD,is currently of most widely acknowledged tumor marker in clinical laboratory.Most tumors secreting CEA are located in cavity viscera, e.g.,gastrointestinal tract,respiratory tract.Owing to its large molecular weight,CEA generated from malignant pleural effusion is difficult to enter blood circulation, meanwhile,CEA in blood circulation is destructed by liver.Therefore,the level of CEA in malignant pleural effusion is distinctively higher than that in serum.The high level of CEA means that the tumor is malignant.The changes of VEGF,sFas and CEA respectively in pleural effusion had been investigated,whereas the co-detection hasn't been studied.Accordingly,the purpose of our study is to evaluate the differential diagnosis value of VEGF,sFas and CEA in hydrothorax diagnosis through a co-detection.Materials and Methods:90 cases of primarily admitted pleural effusion were selected,of which 33 cases were malignant,33 cases were tuberculous,and the remains were transudate.Before therapy,the first batch of pleural effusion specimen(about 10ml) was sampled. ELISA and electrochemiluminescence immunization analytical technique were introduced to determine the levels of VEGF,sFas and CEA.Results:1.The levels of VEGF,sFas and CEA in three groups.In the group of lung cancer malignant pleural effusion,the levels of VEGF,sFas and CEA were respectively(393.407±183.125)pg/ml,(202.952±82.304)pg/ml and(95.012±167.686)ng/ml;whlie the levels in the tuberculous group were (250.658±143.074) pg/ml,(117.094±70.474) pg/ml and(2.485±1.186) ng/ml;and in the transudate group were(158.896±114.736) pg/ml,(59.571±12.573)pg/ml and (1.983±0.885) ng/ml.The levels of all three markers were significantly higher in malignant pleural effusion than in tuberculous hydrothorax group and transudate group.Comparison among groups was conducted by analysis of variance,and F values of VEGF,sFas and CEA were respectively 16.04,34.31 and 8.69,p＜0.05. Comparison within groups(malignant-tuberculous) was conducted by SNK test and q values were respectively 5.32,7.47 and 5.23,p＜0.05.Compared with the transudate group,the VEGF and sFas levels were distinctively higher in the tuberculous pleural effusion group(q values were respectively 3.14,4.59,p＜0.05;while the CEA levels had no significant difference between groups(q=0.03,P＞0.05).2.The diagnostic value of three single detection for malignant pleural effusion.Sensitivity,specificity,positive predictive values and negative predictive value of VEGF,sFas and CEA in single detecting were respectively(75.8%,84.2%,73.5%, 85.7%),(72.7%,93%,85.7%,85.5%),(75.8%,94.7%,89.3%,87.1%).And among them,specificity and negative predictive values were all high,and were respectively(84.2%,85.7%),(93%,85.5%),(94.7%,87.1%).The positive predictive values of sFas and CEA were as high as 85.7%,and 89.3%,while the value of VEGF relatively lower as 73.5%.The sensitivity of the three markers was respectively 78.8%,72.7%and 78.8%,which was not ideal.3.The diagnostic value of three joint monitoring for malignant pleural effusion.Sensitivity,specificity,positive predictive values and negative predictive value of VEGF+CEA,VEGF+sFas and CEA+sFas in co-detection were respectively (100%,84.2%,78.6%,100%),(90.9%,80.7%,73.2%,93.9%)and(97%, 94.7%,91.4%,98.2%).Co-detection of two markers distinctively increased sensitivity and negative predictive value,specialy the co-detection of VEGF+CEA and CEA+sFas.It's significantly increased compared to signle monitoring(p＜0.05).The specificity and positive predictive values of theer co-detection methods of VEGF,CEA and sFas slightly decreased compared with single monitoring(p＞0.05).sFas +CEA got the best results that the four evaluations were all ideal and met the need of the differential diagnosis.The sensitivity,specificity,positive predictive values and negative predictive value of co-detection of VEGF+CEA +sFas were respectively 100%,80.7%, 75%and100%.The sensitivity and negative predictive value were increased compared with single detection(p＜0.05),and there wasn't significant difference in specificity and positive predictive value(p＞0.05).The sensitivity and negative predictive value was the same with those of the co-detection of VEGF+CEA,and the specificity and positive predictive value was lower than those of the co-detection of VEGF+CEA. The results exceled single monitoring but did not excel the joint monitoring of sFas +CEA.The four evaluations is worse than those of sFas+CEA.Conclusions:1.The VEGF,sFas and CEA levels in malignant pleural effusion are significantly higher than that in benign groups.2.The specificity and negative predictive value of VEGF,sFas and CEA are all higher in single monitoring but the sensitivity is not perfect.3.Co-detection of VEGF,sFas and CEA has a meaningful clinical value for differential diagnosis Between benign and malignant pleural effusion and is superior to single monitoring,but not Superior to the joint monitoring of sFas + CEA.,which has satisfactory efficiency.
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