Diagnostic Value Of Combined Detection Of Multiple Biological Indicators For Differentiating Benign And Malignant Pleural Effusion

Objective:The differential diagnosis value of CEA,LDH/ADA,D-Dimer(D-D)in serum and c-reactive protein/albumin ratio(CAR)in serum in patients with pleural effusion was investigated.Methods:The clinical data of 235 patients with pleural effusion in affiliated hospital of north sichuan medical college from January 2018 to August 2019 were retrospectively analyzed.According to the inclusion and exclusion criteria,30 patients who did not meet the criteria were excluded.Then patients were divided into malignant group and benign group according to different causes of pleural effusion,and further divided into tuberculosis group and pneumonia-like group.Age,sex,clinical symptoms,CEA,LDH and ADA amounts in thoracic fluid,D-D amounts in plasma,c-reactive protein and albumin amounts in each group were collected.The differences in age,gender,clinical symptoms,CEA amounts and LDH/ADA ratio in thoracic fluid,and D-D amounts in plasma and CAR in different groups of patients were compared.Then,the independent predictors of malignant pleural effusion were analyzed by binary Logistic regression,and the ROC curve was drawn to analyze the differential diagnosis value of each indicator in benign and malignant pleural effusion.Results:finally,45 cases(27 males and 18 females,mean age 66.76±11.46 years)were included in the malignant group,117 cases(80 males and 37 females,mean age 34.71 ± 14.36 years)in the tuberculosis group,and 43 cases(33 males and 10 females,mean age 59.14±15.91 years)in the pneumonia-like group.The malignant group had the oldest patients,the tuberculosis group had the smallest,and the pneumonia-like group was in the middle.The pairwise comparison between the three groups was statistically significant(all P<0.05).There was no significant difference in gender between the three groups(P>0.05).Bilateral pleural effusion in the malignant group(24.4%)was more common than that in the tuberculosis group(11.1%),and the difference was statistically significant(P<0.05).Compared with the benign group(tuberculosis group+pneumonitis group),the symptoms of chest tightness,dyspnea,wasting,hemoptysis and palpitation in the malignant group were more common than those in the benign group,and fever was less common than that in the benign group,with statistically significant differences(all P<0.05).CEA amount in pleural effusion in the malignant group was significantly higher than that in the benign group(tuberculosis group+pneumonia-like group),and the difference was statistically significant(P<0.01).Furthermore,the CEA amounts in pleural effusion in the malignant group were higher than that in the tuberculosis group and the pneumonia-like group,with statistically significant differences(all P<0.01).Compared with the tuberculosis group and the pneumonia-like group,the difference were not statistically significant(P>0.05).CEA of pleural effusion was an independent predictor of malignant pleural effusion,with the area under the curve(AUC)of 0.94 and the sensitivity and specificity of 6.16ng/mL were 84%and 98%,respectively.the LDH/ADA ratio of pleural effusion in the malignant group was significantly higher than that in the benign group,with statistically significant difference(P<0.01).The LDH/ADA ratio of the malignant group and the pneumonia-like group were higher than that of the tuberculosis group,and the difference were statistically significant(all P<0.01).However,there were no significant difference in LDH/ADA ratio between the malignant group and the pneumonia-like group(P>0.05).Thoracic fluid LDH/ADA was also an independent predictor of malignant pleural effusion,with an AUC of 0.78 and a sensitivity and specificity of 73%and 74%,respectively,when 15.02 was taken as the critical value.plasma D-D amount in the malignant group was significantly higher than that in the benign group,with statistically significant difference(P<0.01).Furthermore,the plasma D-D amounts in the malignant group were higher than that in the tuberculosis group and the pneumonia-like group,with statistically significant differences(all P<0.01).However,there were no significant difference between tuberculosis group and pneumonia-like group(P>0.05).Plasma D-D was also an independent predictor of malignant pleural effusion,with an AUC of 0.93.When 3.98 mg/L was taken as the critical value,the sensitivity and specificity were 93%and 82%,respectively.Plasma CAR were the highest in the pneumonia-like group,followed by the malignant group,and the lowest in the tuberculosis group.CAR in the malignant group were significantly higher than that in the benign group,and the difference were statistically significant(P<0.01).Furthermore,the comparison were further divided into subgroups,and the pairwise comparison among malignant group,tuberculosis group and pneumonia-like group showed statistically significant differences(all P<0.05).But CAR is not an independent predictor of malignant pleural effusion.The AUC of CEA,LDH/ADA and plasma D-D was 0.95?0.98,the sensitivity was 86%?95%,and the specificity was 87%?98%.The sensitivity and specificity were significantly higher than those of CEA combined with D-D,and the AUC,sensitivity and specificity were the best.If the three indicators were combined,the AUC was 0.99,the sensitivity 95%,and the specificity 96%.AUC values of CEA+LDH/ADA+D-D were compared with CEA,LDH/ADA,and D-D,and the differences were statistically significant(all P<0.05).Conclusion:Malignant pleural effusion tends to occur in middle-aged and elderly people,and the common symptoms include chest tightness,dyspnea,emaciation,hemoptysis and palpitations.CEA amount,LDH/ADA ratio,plasma D-D amount and CAR in thoracic fluid in patients with malignant pleural effusion were significantly higher than those in patients with benign pleural effusion.CEA in thoracic fluid,LDH/ADA and plasma D-D were independent predictors of malignant pleural effusion,while CAR was not an independent predictor of malignant pleural effusion.Pleural effusion CEA and plasma D-D are of great value in the differential diagnosis of benign and malignant pleural effusion,while LDH/ADA has a relatively low value in the differential diagnosis.4.Combined detection of pleural effusion CEA,LDH/ADA,plasma D-D and other indicators can reduce the missed diagnosis and misdiagnosis rate of malignant pleural effusion,and significantly improve the sensitivity and specificity of diagnosis in the differential diagnosis of benign and malignant pleural effusion,which has important clinical diagnostic value.