肿瘤标志物和血清腹水白蛋白梯度在恶性腹水诊断中的价值

Clinical value of tumour markers and serum-ascites albumin gradient in diagnosis of malignant ascites

目的探讨肿瘤标志物和血清腹水白蛋白梯度（SAAG）在恶性腹水诊断中的应用价值。方法回顾性研究2005年1月至2008年1月收治的114例腹水患者，根据腹水病因分为恶性腹水组39例和良性腹水组105例（其中结核性腹水12例、无菌性肝硬化腹水93例）。分析腹水和血清癌胚抗原（CEA）、糖链抗原（CA）19—9、CA125和SAAG在良、恶性腹水中分布的差异，并构建受试者工作（ROC）曲线。结果在恶性和良性腹水患者中均检出肿瘤标志物。恶性腹水患者的血清CEA和CA19-9、腹水CEA和CA19-9均明显高于良性腹水患者（P〈0．05）。恶性腹水患者的SAAG明显低于肝硬化腹水患者（P〈O．05），而与结核性腹水患者差异无统计学意义（P〉0．05）。恶性腹水患者的血清和腹水CA125与良性腹水患者差异均无统计学意义（P〉0．05）。腹水CEA、CA19—9和SAAG的曲线下面积分别为0．79、0．82和0．85；准确度最高的临界值分别是1．45U／L、19．50U／L和13．50g／L，敏感度和特异度分别是66．7％和78．1％、74．4％和84．8％及82．9％和84．6％。联合检测价值最好的组合为SAAG和腹水CA19-9，其敏感度和特异度为61．54％和97．14％。结论通过ROC曲线寻找最佳的生化指标组合鉴别良、恶性腹水是可行的。

Objective To investigate the clinical value of tumour markers and serum-ascites albumin gradient （SAAG） in diagnosis of malignant ascites. Methods One hundred and fourteen patients with ascites, who were admitted to the hospital between Jan. 2005 and Jan. 2008, were retrospectively reviewed. The patients were divided into malignant （n= 39） or benign （12 with tuberculosis and 93 with aseptic liver cirrhosis） ascites groups according to the etiology. The distribution of tumor markers （CEA, CA19-9 and CA125） and SAAG in both groups were analyzed and receiver operating characteristic （ROC） was constructed. Results The tumor markers and SAAG were found both in malignant ascites group and benign ascites group. The concentrations of CEA and CA19-9 in serum and ascites were higher in malignant ascites group than in benign ascites group. The SAAG in malignant ascites group was significantly lower than that in patients with liver cirrhosis （P〈 0.05）, but had no difference in comparison with tuberculosis patients （P〉0.05）. There was no difference in level of CA125 in serum or ascites between malignant ascites group and benign ascites group （P〉0.05）. The area under the curve of ascitic fluid CEA, CA19-9 and SAAG were 0.79, 0.82 and 0.85, respectively. The cutoff values of ascitic fluid CEA, CA19-9 and SAAG were optimally chosen at 1. 45 μ/L, 19. 50 μ/L and 13. 50 g/L, respectively. The sensitivity and specificity were 66.7% and 78.1% in CEA, 74.4% and 84.8% in CA19-9, as well as 82.9% and 84.6% in SAAG. The combination of ascitic fluid CA19-9 with SAAG could increase the specificity to 97.14%, but decrease the sensitivity to 61.54%. Conclusion It is feasible to achieve optimum combination of biochemical indicators using ROC in differential diagnosis of malignant ascites from benign ascites.