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Title: [The value of B7-H4 and carcinoembryonic antigen in diagnosing the benign and malignant pleural effusion].
Author: Wei F, Wei Y, Li LF, Li GL, Wang GJ.
Journal: Zhonghua Zhong Liu Za Zhi; 2017 Jul 23; 39(7):524-527. PubMed ID: 28728299.
Abstract:
Objective: To evaluate the value of combined detection of negative costimulatory molecule B7-H4 and carcinoembryonic antigen (CEA) in diagnosing malignant and benign pleural effusion. Methods: Ninety-seven pleural effusion specimen were collected, 55 of which were diagnosed as malignant pleural effusion and 42 were benign pleural effusion. Enzyme-linked immunosorbent assay(ELISA) was used to examine the concentration of B7-H4 and CEA in pleural effusion. Electro-chemiluminescence immunoassay was used to detect the CEA level in pleural effusion. Receiver operating characteristic (ROC) curve was established to analyze and evaluate the single or combined detection of B7-H4 and CEA in diagnosing malignant and benign pleural effusion. Results: The concentrations of B7-H4 and CEA in malignant pleural effusion (MPE) group were (60.08±35.04) ng/ml and (41.49±37.16) ng/ml, respectively, obviously higher than (27.26±9.55) ng/ml and (2.41±0.94) ng/ml of benign pleural effusion (BPE) group (both P<0.01). Area under curve (AUC) of B7-H4 was 0.884 in MPE groupand the diagnostic sensitivity and specificity were 81.8% and 90.5%, respectively, at the optimized cut off value of 37.25 ng/ml. Likewise, area under curve (AUC) of CEA was 0.954 and the sensitivity and specificity were 87.3% and 95.2%, respectively, at the cut off value of 4.18 ng/ml. When B7-H4 >37.25 ng/ml or CEA>4.18 ng/ml, the sensitivity of diagnosis as MPE was down-regulated to 90.9% and the specificity was elevated to 88.1%. When B7-H4 >37.25 ng/ml and CEA>4.18 ng/ml, the sensitivity of diagnosis as MPE was down-regulated to 78.2% and the specificity was elevated to 97.6%. The sensitivity and specificity of combined detection of B7-H4 and CEA to diagnose MPE were elevated to 90.9% and 97.6%, respectively. The level of B7-H4 in MPE and BPE were both positively correlated with CEA (r=0.670, P=0.001 in MPE and r=0.002, P=0.001 in BEP). Conclusions: B7-H4 is a potential tumor marker in diagnosing the benign and malignant pleural effusion. Although the diagnostic value of B7-H4 may not precede to CEA, the combined detection of B7-H4 and CEA can improve the diagnostic sensitivity and specificity of MPE. 目的： 探讨B7－H4和癌胚抗原(CEA)联合检测鉴别诊断良、恶性胸腔积液的价值。 方法： 收集97例胸腔积液标本，其中恶性胸腔积液55例，良性胸腔积液42例。采用酶联免疫吸附法检测B7－H4水平，采用电化学发光法检测CEA水平，采用受试者工作特征(ROC)曲线评价B7－H4、CEA和B7－H4联合CEA检测对良、恶性胸腔积液的鉴别诊断价值。 结果： 恶性胸腔积液组和良性胸腔积液组患者的B7－H4水平分别为(60.08±35.04 )ng/ml和(27.26±9.55)ng/ml，CEA水平分别为(41.49±37.16 )ng/ml和(2.41±0.94)ng/ml，两组患者的B7－H4和CEA水平差异均有统计学意义(均P<0.01)。B7－H4诊断恶性胸腔积液的ROC曲线下面积为0.884，最佳诊断临界值为37.25 ng/ml，敏感度和特异度分别为81.8%和90.5%。CEA诊断恶性胸腔积液的ROC曲线下面积为0.954，最佳诊断临界值为4.18 ng/ml，敏感度和特异度分别为87.3%和95.2%。B7－H4和CEA并联检测，即B7－H4>37.25 ng/ml或CEA>4.18 ng/ml时，则为恶性胸腔积液，其敏感度可提高至90.9%，特异度降低至88.1%；B7－H4和CEA串联检测，即B7－H4>37.25 ng/ml且CEA>4.18 ng/ml时，则为恶性胸腔积液，其敏感度降低至78.2%，特异度提高至97.6%。B7－H4和CEA联合检测时，敏感度和特异度可分别提高至90.9%和97.6%。恶性胸腔积液中B7－H4与CEA水平呈正相关(r＝0.670，P＝0.001)，良性胸腔积液中B7－H4与CEA水平呈正相关(r＝0.002，P＝0.001)。 结论： B7－H4可鉴别诊断良、恶性胸腔积液，但诊断效能未优于CEA。B7－H4和CEA联合检测可提高诊断恶性胸腔积液的敏感度和特异度。.

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