Abstract: Objective To study the diagnostic value of detection of adrenomedullin(AM) and combineddetection of with CYFRA211,NSE and CEA in differentiating malignant pleural effusion from tuberculosis pleural effusion,comparing with CYFRA211,NSE and CEA,to prove the experimental basis of differential diagnosis of malignant pleural effusion.Method The levels of AM,CYFRA211,NSE and CEA in malignant pleural effusion and tuberculosis pleural effusion were determined by radioimmunoassay(RIA) and the sensitivity,specificity and accuracy for making diagnosis of malignant pleural effusion were compared.Results (1)The level of AM in the malignant pleural effusion(115.05±31.06 pg/ml) are significantly higher than that in the tuberculosis pleural effusion(71.404±10.80 pg/ml).There was markedly statistical significance between them(P<0.01);(2)The sensitivity and accuracy for making diagnosis of malignant pleural effusion of AM were higher than those of CEA and NSE(P<0.05).There was no difference between AM and CYFRA211 in the sensitivity and accuracy(P>0.05).(3)The sensitivity and accuracy of the combined determination containing four tumor markers were 90.4% and 89.4%,were higher than any single tumor markers in diagnosis of malignant pleural effusion(P<0.05).Conclusion (1)AM can be regarded as a laboratory mark of differentiating malignant pleural effusion from tuberculosis pleural effusion;(2)Combined detection of AM,CYFRA211,NSE and CEA can ignificantly improve the sensitivity and the accuracy in diagnosis of malignant pleural effusion;(3)This research shows that AM is closely correlated with malignant pleural effusion,disrupting the binding of AM and its receptor or signal transduction pathways could be a new way to cure malignant pleural effusion.

Key words: Adrenomedullin(AM), CYFRA211, NSE, CEA, Pleural effusion