腹水中TB-AB、ADA和sCD44v6的检测及意义

Detection and significance of TB-AB,ADA and sCD44v6 in ascites

目的:探讨可溶性CD44v6(sCD44v6)、腺苷脱氨酶(adenosine deaminase,ADA)和结核抗体(mycobac-terium tuberculosis antibody,TB-AB)联合检测对良、恶性腹水的鉴别诊断价值。方法:取48份结核性腹水、39份恶性腹水,分别用酶联免疫吸附试验(ELISA)、酶速率法及胶体金标法检测腹水sCD44v6、ADA及TB-AB水平。结果:恶性腹水组sCD44v6水平为(102.2±30.6)ng/ml,明显高于结核性腹水组(43.5±15.3)ng/ml(P<0.01);结核性腹水组ADA水平为(55.3±22.4)U/L,明显高于恶性腹水组(21.6±12.7)U/L(P<0.01)。结核患者血清ADA水平为(44.5±17.1)U/L,明显高于恶性肿瘤患者血清ADA水平(25.6±13.8)U/L(P<0.01)。以60.5ng/ml为阳性界值,sCD44 v6诊断恶性腹水的敏感度为82.1%、特异度为87.5%。以45U/L为阳性界值,ADA诊断结核性腹水的敏感度为83.3%、特异度为87.2%。以腹水/血清ADA比值>1.0为阳性界值,诊断结核性腹水的敏感度、特异度分别为89.6%、92.3%。TB-AB诊断结核的敏感度及特异度分别为85.4%及87.2%,诊断恶性肿瘤的敏感度为5.1%。TB-AB、ADA及P-ADA/S-ADA联合检测,诊断结核性腹水的敏感度、特异度分别为95.8%、94.9%。结论:TB-AB、ADA和sCD44v6对于良、恶性腹水的鉴别诊断有重要价值。

Objective：To investigate the diagnostic value of combined detection soluble CD44v6（sCD44v6）,adenosine deaminase（ADA） and tuberculosis antibody（TB-AB） in benign and malignant ascites.Methods： Total of 48 cases of tuberculous ascites and 39 cases of malignant ascites were treated by enzyme-linked immunosorbent assay（ELISA）,enzyme kinetic method and gold standard assay for ascites sCD44v6,ADA and TB-AB levels.Results： sCD44v6 level in malignant ascites（102.2±30.6）ng/ml,was significantly higher than that in tuberculous ascites（43.5 ± 15.3） ng / ml（P0.01）;tuberculous ascites ADA level（55.3±22.4）U/L,was significantly higher than malignant ascites（21.6±12.7）U/L（P0.01）.Serum ADA level of TB patients（44.5±17.1）U/L,significantly higher than patients with malignant tumors（25.6±13.8）U/L（P0.01）.To 60.5 ng/ml as positive community value,sCD44v6 diagnosis of malignant ascites sensitivity was 82.1% and specificity was 87.5%.45U/L as positive community value,ADA diagnosis of tuberculous ascites had a sensitivity of 83.3% and specificity was 87.2%.Ascites / serum ADA ratio 1.0 as positive community value,diagnosis of tuberculous ascites sensitivity and specificity were 89.6%,92.3%.TB-AB for diagnosing tuberculous ascites sensitivity and specificity were 85.4% and 87.2%,the sensitivity of diagnosis of malignancy was 5.1%.TB-AB,ADA and P-ADA/S-were ADA joint detection,diagnosis of tuberculous ascites sensitivity and specificity were 95.8%,94.9%.Conclusion：TB-AB,ADA and sCD44v6 are of great value in the differential diagnosis for benign and malignant ascites.