生化指标检测在腹水鉴别诊断中的评价

Routine clinical biochemical tests of ascites in the differential diagnosis of malignant and benign ascites

目的:评价腹水生化指标在腹水鉴别中的诊断效率,探讨单项及组合指标的临床应用价值。方法:测定64例腹水患者,其中恶性腹水者30例,非恶性腹水者34例,用受试者工作特征曲线(ROC)评价腹水总蛋白(TP)、乳酸脱氢酶(LD)、胆固醇(TC)、白蛋白(ALB)、纤维连接蛋白(FN)、糖(GLU)等,指标敏感度和特异度,分析联合检测的诊断效率。结果:单项检测TP、LD、TC、ALB、FN、GLU的敏感度分别为96.7%、90.0%、90.0%、93.3%、90.0%、73.3%;特异度为85.3%、88.2%、88.2%、82.4%、88.2%、79.4%;ROC曲线下面积为0.93、0.93、0.92、0.89、0.85、0.80。2项联合检测(FN与LD或LD与TC)的敏感度、特异度、阳性似然比、诊断准确度分别为89.3%、90%、9.5、90.6%。而FN、TC、LD与TP组合敏感度和特异度分别为86.7%和93.3%,但阳性似然比却都降为7.7。3项联合检测(FN、LD、TC)敏感度、特异度、阳性似然比、诊断准确度分别为83.3%、85.3%、13.8、91.5%。结论:检测腹水TP、LD、TC、ALB和FN对于鉴别良恶性腹水具一定诊断价值,多项指标联合检测,尤其FN、LD、TC3项指标联合,可明显提高诊断效率。

Objective To study the routine clinical biochemical tests of ascites in the differential diagnosis of malignant and benign ascites, and to discuss the diagnostic characteristics of each single test and multi-test. Methods Ascitic total protein （TP）, albumin （ALB）, lactose dehydrogenase （LD）, fibronectin （FN）, total cholesterol （TC） and glucose （GLU） were determined in 64 patients, including 34 benign and 30 malignant. The sensitivity and the specificity of each test was evaluated by relative operating characteristics curve （ROC curve）, positive likelihood ratio （＋LR） and negative likelihood ratio （-LR）. Results The areas under various ROC curve were 0.93 tiP）, 0.92 （LD）, 0.92 （TC）, 0.89 （ALB）, 0.84（FN）） and 0.80 （GLU）, respectively. The diagnostic sensitivity was 96.7（TP）, 90（LD）, 90（TC）, 93.3（ALB）, 90（FN） and 73.3（GLU）, respectively, while the specificity was 85.3（TP）, 88.2（LD）, 88.2（TC）, 82.4（ALB）, 88.2（FN） and 79.4（GLU）, respectively. When two tests were used simultaneously, the sensitivity, specificity, ＋LR and diagnostic accuracy of Fn with LD or LD with TC were 89.3% ,90% ,9.5 and 90.6%, respectively. When Fn, LC with LD or TP, TC with TP were used simultaneously, their sensitivity and the specificity were 86.7% and 90% respectively; however, the ＋LR all fell to 7.7. When Fn, LD and TC were combined, the diagnostic sensitivity was 83.3%, the specificity was 85.3%, the positive likelihood ratio was 13.8 and the diagnostic accuracy was 91.5%. Conclusions TP, LD, TC, ALB and FN can be used for differential diagnosis between malignant and benign ascites. The application of multi-test, especially, the combination of Fn, LD and TC, could obviously elevate the diagnostic accuracy.