目的 研究多层螺旋CT(MSCT)联 合肿瘤标志物对癌性与结核性胸腔积液鉴 别诊断的临床价值。方法 对40例癌性胸 腔积液(观察组)、50例结核性胸腔积液 (对照组)患者MSCT影像学资料及肿瘤标志 物检测资料进行回顾性分析，比较两组患 者CT值、胸腔积液CA199、CA153、CEA水 平，以病理结果为依据，比较MSCT、肿 瘤标志物单一、联合对胸腔积液性质诊 断的敏感度、特异度。结果 观察组典型 MSCT征象为胸膜弥漫性或局限性增厚，占 92.5%；纵隔移位占20.0%，均显著高于对 照组的26.0%、2.0%(P＜0.05)。增强扫 描癌性胸腔积液明显强化显著优于对照 组(P＜0.05)。观察组胸腔积液CA199、 CA153、CEA水平均明显高于对照组(P ＜0.05)。MSCT+CA199+CA153+CEA诊断癌 性与结核性胸腔积液敏感度、特异度均显 著高于MSCT、CEA、CA199+CA153检查(P ＜0.05)。结论 MSCT、肿瘤标志物对癌性 与结核性胸腔积液鉴别诊断均有一定的价 值，两者联合检测能有效提高诊断敏感度 及特异度。

Objective To study the clinical value of multi-slice spiral CT (MSCT) combined with tumor markers in the differential diagnosis of cancerous and tuberculous pleural effusion. Methods The MSCT imaging data and data of tumor marker detection of 40 patients with cancerous pleural effusion (observation group) and 50 patients with tuberculous pleural effusion (control group) were analyzed retrospectively. The CT value, levels of CA199, CA153 and CEA in pleural effusion were compared between the two groups. Based on the pathological results, the sensitivities and specificities of MSCT, tumor markers alone and combined in the diagnosis of character of pleural effusion were compared. Results The typical MSCT signs of the observation group were pleural diffuse or localized thickening (92.5%) and mediastinal shift (20.00%) which were significantly higher than those in the control group (26.0%, 2.0%) (P<0.05). The enhancement of cancerous pleural effusion scanned by enhanced scan in the observation group was significantly better than that in the control group (P<0.05). The levels of pleural effusion CA199, CA153 and CEA in the observation group were significantly higher than those in the control group (P<0.05). The sensitivity and specificity of MSCT+CA199+CA153+CEA in the diagnosis of cancerous and tuberculous pleural effusion were significantly higher than those of MSCT, CEA and CA199+CA153 (P<0.05). Conclusion MSCT and tumor markers have certain value in the differential diagnosis of cancerous and tuberculous pleural effusion. The combined detection of the two can improve the diagnostic sensitivity and specificity.