腹水和血清中肿瘤标志物水平及其相关性分析在良恶性腹水鉴别诊断中的价值

Clinical value of tumor biomarkers in ascitic fluid and serum in differentiating benign from malignant ascites and their correlation

目的 探讨腹水及血清中肿瘤标志物水平及其相关性在良恶性腹水鉴别中的作用.方法 选取武汉大学人民医院2006年7月至2009年7月有腹腔积液并同时行腹腔穿刺的67例病例,根据病因将其分为良性腹水组和恶性腹水组,分析各组病例血清、腹水中肿瘤标志物含量,对其进行相关性分析,同时对各项肿瘤标志物的诊断敏感性和特异性进行评估.结果 良性腹水组与恶性腹水组血清及腹水中糖链抗原（CA）199含量差异均具有统计学意义（均P＜0.01）,恶性腹水组腹水中癌胚抗原（CEA）明显升高（P＜0.05）.良性腹水组血清中CA199、CEA的含量较腹水中明显升高,CA125却显著降低（P＜0.01或＜0.05）,血清与腹水中仅有AFP呈高度相关（r=0.992,P＜0.01）.在恶性腹水组,腹水中CA199、CEA及C A125含量较血清中显著升高（P＜0.01或＜0.05）,血清与腹水中CA199、CEA呈高度相关（r值分别为0.746、0.572,均P＜0.01）,AFP相关程度亦有统计学意义（r=0.384,P＜0.05）.CA199和CEA腹水血清中含量之比（F/S）在恶性腹水组中明显升高（P＜0.05或＜0.01）.CA199、CEA和CA125三项联合检测在诊断上有较高的敏感性和特异性（P＜0.05）.结论 CA199、CEA的测定有助于良恶性腹水的鉴别,血清肿瘤标志物的检测不能完全代替腹水肿瘤标志物的检测,CA199、CEA和CA125的联合检测能够提高诊断的敏感性和特异性.

Objective To evaluate clinical value of tumor biomarkers in ascitic fluid and serum in differentiating benign from malignant ascites and their correlation. Methods From July 2006 to July 2009,67 patients with ascites undergone abdominal paracentesis in Renmin Hospital of Wuhan University were enrolled in the study and divided into malignant and benign groups according to their etiology. Levels of tumor biomarkers in ascitic fluid and serum were determined and their correlation were analyzed. Diagnostic sensitivity and specificity of tumor markers were evaluated. Results There was statistically significant difference in levels of cancer antigen 199 （CA199） in serum and ascitic fluid between the malignant group and the benign one （ P ＜ 0. 01 ）, and level of cancer embryonic antigen （CEA） significantly increased in ascitic fluid （P ＜ 0.05 ）. Levels of CA199 and CEA in serum were significantly higher than those in ascetic fluid in the benign group （P ＜ 0. 01 and P ＜ 0. 05 ）, and level of CA125 was significantly lower in serum than that in ascitic fluid （P ＜ 0. 01 ）. Level of alpha-fetal protein （AFP） in serum significantly correlated with that in ascitic fluid in the benign group （r =-0. 992, P ＜0. 01 ）. In the malignant group, levels of CA199, CEA and CA125 were significantly higher in ascitic fluid than those in serum （P ＜0.05 or P ＜0. 01 ）. Levels of CA199 and CEA in serum significantly correlated with those in ascetic fluid in the malignant group （r =0. 746 and 0. 572, respectively, P ＜0. 01 ）, and level of AFP in serum also correlated with that in ascetic fluid （r=0. 384, P ＜0. 05）. Ratios of levels of CA199 and CEA in ascetic fluid to those in serum （F/S） were significantly higher in the malignant group than those in the benign group （P ＜0.05 or P ＜0.01）. Use of combination of CA199, CEA and CA125 determinations showed a higher sensitivity and specificity in differential diagnosis for benign and malignant ascites （P ＜0.05）. Conclusions Determinations of CA199 and CEA are beneficial for differentiating benign ascites from malignant one. Determinations of tumor biomarkers in serum can not fully replace those in ascetic fluid. Combined determinations of CA199, CEA and CA125 can increase their sensitivity and specificity in diagnosis for malignant ascites.