DNA倍体分析与癌胚抗原检测对良、恶性腹水鉴别诊断的意义

Significance of DNA ploidy analysis and carcinoembryonic antigen assay for differential diagnosis between benign and malignant ascites

目的:探讨DNA倍体分析与癌胚抗原(carcinoembryonic antigen,CEA)检测对良、恶性腹水鉴别诊断的意义.方法:应用流式细胞术对106例腹水患者(良性腹水50例,原发性肝癌并腹水31例,非肝癌恶性腹水25例)进行腹水细胞DNA倍体分析,以腹水细胞中发现异倍体为阳性;同时采用ELISA法进行腹水及血清CEA测定,以血清或腹水CEA浓度>5μg/L、腹水/血清CEA比值>1为阳性.结果:腹水CEA、腹水/血清CEA比值阳性和腹水中检出异倍体鉴别肝癌并腹水及非肝癌恶性腹水与良性腹水的灵敏度和特异度分别为35.48%,84%及72%,84%;35.48%%,98%及72%,98%;70.97%,86%和71.43%,86%.腹水中检出异倍体与腹水/血清CEA比值阳性联合检测鉴别肝癌并腹水及非肝癌恶性腹水与良性腹水的灵敏度分别为93.55%和92%,特异度均为100.00%.结论:DNA倍体分析联合腹水/血清CEA比值检测对于鉴别良、恶性腹水是有价值的生物学指标.

AIM： To investigate the differential diagnostic significance of DNA ploidy analysis and serum, ascetic carcinoembryonic antigen （CEA）, ascites/ serum CEA ratios assay in malignant （PHC and non-PHC malignancy） and benign ascites.METHODS： Flow cytometry （FCM） was used for DNA ploidy analysis and enzyme linked im- munosorbent assay （ELISA） for CEA assay in 56 malignant （31 PHC and 25 non-PHC） ascites. As a control, 50 nonmalignant ascites were evalu- ated at the same time. If the serum or ascitic CEA value 〉5 μg/L, and the ascites/serum CEA ratios 〉1, then the CEA assay was defined as positive. If an aneuploidy was detected, the re- sult of the DNA ploidy analysis was defined as positive.RESULTS： The sensitivity and specificity of ascitic CEA, ascites/serum CEA ratios〉l and aneuploidy in differential diagnosis of PHC ascites and non-PHC with malignant ascites or with benign ascites were 35.48%, 84% and 72%, 84%; 35.48%, 98% and 72%, 98%; 70.97%, 86% and 71.43%, 86%, respectively. The sensitivity and specificity of the combination assay of aneu- ploidy and ascites/serum CEA ratios 〉1 in dif- ferential diagnosis of PHC ascites and non-PHC with malignant ascites or with benign ascites were 93.55%, 100%; 92%, 100%, respectively.CONCLUSION： Our study confirmed the dif- ferential diagnostic value between benign and malignant ascites of the combination assay of ascites/serum CEA ratios assay and the DNA ploidy analysis.