T淋巴细胞亚群和DNA倍体检测在腹水鉴别诊断中的价值

Value of T lymphocyte subset determination and DNA ploidy analysis for differential diagnosis of ascites

目的:探讨T淋巴细胞亚群和DNA倍体检测在腹水鉴别诊断中的价值.方法:腹水患者74例,其中结核性腹膜炎24例,肝硬化21例,癌性腹水29例,流式细胞仪测定腹水T淋巴细胞亚群和DNA倍体.结果:腹水中T淋巴细胞(CD3^+)、T辅助/诱导细胞亚群(CD4^+)、T辅助细胞亚群/T抑制细胞亚群(CD4^+/CD8^+)所占比例从大到小依次为结核性腹膜炎(CD3^+:86.2%±5.1%,CD4^+:64_3%±6.4%,CD4^+/CD8^+:3.20%±0.30%)、癌性腹水(65.7%±4.6%,32.5%±2.2%,1.04%±0.11%)、肝硬化腹水(15.1%±2.7%,3.6%±0.5%,0.36%±0.05%)(三组间P<0.01),CD8^+比例从小到大依次为肝硬化腹水(10.1%±3.2%)、结核性腹膜炎(20.1%±4.3%)、癌性腹水(31.3%±5.2%)(三组间P<0.01).腹水DNA倍体阳性率癌性腹水达89.7%(26/29),与结核性腹膜炎4.2%(1/24)和肝硬化4.7%(1/21)具有显著性差异(P<0.01).结论:T淋巴细胞亚群和DNA倍体在结核性腹膜炎、肝硬化及癌性腹水存在显著差异,其检测可用于腹水的鉴别诊断.

AIM： To investigate the value of T lymphocyte subset determination and DNA ploidy analysis for differential diagnosis of ascites. METHODS： In 74 cases of ascites, 24 with tuberculous peritonitis, 21 with liver cirrhosis and 29 with carcinomatous ascites, T lymphocyte subsets and DNA ploidy in ascitic fluid were detected by flow cytometry. RESULTS： In descending order of T lymphocyte （CD3^＋）, helper/inducer T lymphocyte （CD4^＋）, and helper T lymphocyte/suppressor T lymphocyte （CD4^＋/CD8^＋） in ascitic fluid, tuberculous peritonitis （CD3^＋： 86.2% ＋ 5.1%, CD4~： 64.3% ± 6.4%, CD4^＋/CD8^＋： 3.20% ± 0.30%）, carcinoma- tous ascites （65.7% ± 4.6%, 32.5% ± 2.2%, 1.04 %± 0.11%） and liver cirrhosis （15.1% ±2.7%, 3.6%± 0.5%, 0.36% ± 0.05%） （P 〈 0.01） were determined. In ascending order, CD8^＋, liver cirrhosis （10.1% ± 3.2%）, tuberculous peritonitis （20.1% ± 4.3%） and carcinomatous ascites （31.3% ± 5.2%） （P 〈 0.01） were determined. The positive rate from DNA ploidy analysis in carcinomatous ascites （89.7%, 26/29） was significantly higher than that in tuberculous peritonitis （4.2%, 1/21） or liver cirrhosis （4.7%, 1/27） （P 〈 0.01）. CONCLUSION： T lymphocyte subsets and DNA ploidy in ascitic fluid show obvious differences among patients with tuberculous peritonitis, liver cirrhosis and carcinomatous ascites. T lym- phocyte subset determination and DNA ploidy analysis are thus useful for the differential diagnosis of ascites.