| BackgroundMalignant pleural effusion(MPE)is one of the common complications of tumors and is more common in pleural metastasis caused by lung cancer,gastric cancer,and breast cancer.The diagnosis of malignant pleural effusion mainly depends on cytological and pathological examination to confirm the diagnosis in clinical practice.The commonly used methods include pleural effusion exfoliative cytology,pleural biopsy,thoracoscopic biopsy,etc.The shortcomings lie in the low positive rate of cytological examination,large trauma and high cost of thoracoscopic biopsy.Finding more efficient and non-invasive methods to assist in the diagnosis of MPE is an urgent clinical problem.Relevant literatures have shown that neutrophil to lymphocyte ratio(NLR)and carcino embryonic antigen(CEA)have high diagnostic value in a variety of tumors,and there is no study on the diagnostic value of NLR combined with CEA detection in malignant pleural effusion.ObjectiveThe differences of NLR and CEA levels between benign and malignant pleural effusion were analyzed.Receiver operating characteristic curve(ROC)was established to assess the diagnostic value of NLR and CEA alone and in combination.MethodsA total of 215 patients with pleural effusion,including 110 patients with malignant pleural effusion,including 75 patients with lung adenocarcinoma,11 patients with lung squamous cell carcinoma,12 patients with small cell lung cancer,5 patients with gastric cancer,4 patients with ovarian cancer,3 patients with breast cancer;105 patients with benign pleural effusion,including 77 patients with tuberculous pleurisy and 28 patients with cardiac insufficiency,were enrolled from the First Affiliated Hospital of Zhengzhou University from June 2018 to June 2020.The results of fasting blood routine and biochemical tests were collected the next morning after admission,and the neutrophil count and lymphocyte count were recorded to calculate the NLR level.The results of routine,biochemical,CEA,adenosine deaminase(ADA)and other tests of pleural effusion drained by the first thoracentesis were collected.Data analysis was performed using SPSS 21.0 statistical software,normally distributed data were expressed as mean ± standard deviation(x ±s),and comparison was performed using the t-test.Data not conforming to normal distribution were expressed as median M(P25,P75).Mann-Whitney non-parametric test was used to compare measurement data,and chi-square test(x2 test)was used to compare enumeration data.Binary logistic regression was used to process the indicators and calculate the combined predictive probability of the two,with a predictive probability≥0.5 as malignant,otherwise benign,and ROC curves were established to assess the diagnostic value of NLR and CEA alone and in combination with pathological examination as the diagnostic gold standard,with a test level of α=0.05.Results1.There was no significant difference in general data(including age,gender,smoking history,drinking history,history of underlying diseases,and family history of tumors)between the malignant pleural effusion group and the benign pleural effusion group(P>0.05).There was no significant difference in cough,chest pain,chest distress and hemoptysis between the two groups(P>0.05).The number of cases of fever symptoms was higher in the benign pleural effusion group than in the malignant pleural effusion group,and the difference was statistically significant(P<0.05).Patients in the malignant pleural effusion group had more bloody pleural effusion than those in the benign pleural effusion group,and the difference was statistically significant(P<0.05).2.The levels of NLR,LDH and CEA in malignant pleural effusion group were significantly higher than those in benign pleural effusion group(P<0.05).There was no significant difference in ALT,AST,NT-ProBNP,CRP and ESR between the two groups(P>0.05).The NLR level of malignant pleural effusion in males was higher than that in females,and the difference was statistically significant(P<0.05).There was no significant difference in NLR between non-elderly patients and non-bloody patients with malignant pleural effusion(P>0.05).3.LDH and CEA in pleural effusion were higher in malignant pleural effusion group than in benign pleural effusion group,and ADA was lower in malignant pleural effusion group than in benign pleural effusion group,and the differences were statistically significant(P<0.05).There was no significant difference in the proportion of multinucleated cell count,the proportion of monocyte count,total protein,and pH(P>0.05).There was no significant difference in CEA between non-elderly patients,male patients and non-bloody patients with malignant pleural effusion and elderly patients,female patients and bloody patients(P>0.05).4.ROC curve analysis of NLR,LDH,ADA and CEA indicators alone showed that the AUC of NLR was 0.740,and the optimal cutoff value was cut off 4.19.At this time,the sensitivity and specificity for the diagnosis of MPE were 70.00%and 70.83%,respectively;the AUC of LDH was 0.755,cut off 219.56 IU/L,and the sensitivity and specificity for the diagnosis of MPE were 70.91%and 67.17%,respectively;the AUC of LDH in pleural effusion was 0.611,cut off 312.18 IU/L,and the sensitivity and specificity for the diagnosis of MPE were 54.50%and 69.20%,respectively;the AUC of ADA in pleural effusion was 0.683,cut off 25.26 U/L,and the sensitivity and specificity for the diagnosis of MPE were 54.20%and 85.50%,respectively;the AUC of CEA was 0.804,cut off 2.35 ng/mL,and the sensitivity and specificity for the diagnosis of MPE were 73.58%and 80.42%,respectively.5.The results showed that the AUC of combined detection of NLR+LDH was 0.841,the sensitivity was 77.27%and the specificity was 77.50%in the diagnosis of MPE;the AUC of combined detection of NLR+pleural effusion LDH was 0.757,the sensitivity was 65.55%and the specificity was 75.00%in the diagnosis of MPE;the AUC of combined detection of NLR+pleural effusion ADA was 0.788,the sensitivity was 83.64%and the specificity was 64.17%in the diagnosis of MPE;the AUC of combined detection of NLR+CEA was 0.847,the sensitivity was 75.87%and the specificity was 85.91%in the diagnosis of MPE;the AUC of combined detection of NLR+pleural effusion CEA was 0.906,the sensitivity was 79.09%and the specificity was 94.17%in the diagnosis of MPE.ConclusionThe combined detection of CEA and NLR levels in pleural effusion has good sensitivity and specificity in the diagnosis of malignant pleural effusion,and has important clinical value in the diagnosis of malignant pleural effusion. |
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