腹水端粒酶、DNA倍体、CEA、CA19-9和血清-腹水白蛋白梯度对良恶性腹水的鉴别诊断意义

Significance of Ascitic Telomerase,DNA Ploidy,CEA,CA19-9 and Serum-ascites Albumin Gradient in Differential Diagnosis between Benign and Malignant Ascites

背景：确定腹水的良恶性在临床上具有重要意义,但恶性腹水的早期诊断相对困难,临床常规检测手段的漏诊率较高,且阴性结果不能排除肿瘤.目的：探讨腹水端粒酶、DNA倍体、CEA、CA19-9和血清-腹水白蛋白梯度（SAAG）对鉴别诊断良恶性腹水的意义.方法：纳入77例腹水患者（恶性腹水组41例,良性腹水组36例）,分别检测腹水端粒酶、DNA倍体、CEA、CA19-9、白蛋白和血清白蛋白含量.结果：恶性腹水组腹水端粒酶、DNA异倍体比例、CEA、CA19-9明显高于良性腹水组,SAAG明显低于良性腹水组,差异均有统计学意义（P＜0.01）.腹水端粒酶和CEA的鉴别诊断准确性较高,5项指标联合检测的敏感性显著高于各指标单独检测（P＜0.05）.结论：腹水端粒酶、DNA倍体、CEA、CA19-9和SAAG可用于鉴别诊断良恶性腹水,联合检测可提高诊断敏感性.

Background： The differential diagnosis between benign and malignant ascites is of great significance in clinical practice, and early diagnosis of malignant ascites is relatively difficult. Conventional tests have a high omission diagnostic rate, and the negative results can not exclude the malignancy. Aims： To investigate the significance of telomerase, DNA ploidy, CEA, CA19-9 in ascites and serum-ascites albumin gradient （SAAG） in differential diagnosis of malignant and benign ascites. Methods： Seventy-seven patients with ascites were enrolled, including 41 malignant ascites and 36 benign ascites. Telomerase, DNA ploidy, CEA, and CA19-9 in ascites, as well as albumin in both ascites and serum were determined. Results： The ascitic telomerase, rate of DNA aneuploid, CEA and CA19-9 of malignant ascites group were significantly higher than those of benign ascites group （P〈0.01）, while the SAAG was much lower than that of benign ascites group （P〈0.01）. Telomerase and CEA in ascites had relatively higher diagnostic accuracy and the combined determination of these five parameters had a higher sensitivity than single parameter determination （P〈0.05）. Conclusions： Ascitic telomerase, DNA ploidy, CEA, CA19-9 and SAAG may be used in differential diagnosis of malignant and benign ascites, and the combined determination can enhance the sensitivity.