4种指标在腹水鉴别诊断中的意义

Significance of four parameters in differential diagnosis of ascites

目的探讨腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)及血清-腹水白蛋白梯度(SAAG)在不同病因腹水中的临床意义。方法检测139例腹水患者腹水中ADA、LDH、CEA和SAAG等4种指标,用受试者工作特征曲线(ROC)对它们在腹水病因鉴别诊断中的临床价值进行评估。结果 ADA水平以结核性腹水组为最高,恶性腹水组次之;LDH以恶性腹水组最高,结核性腹水组次之,门脉高压性腹水组最低;CEA含量以恶性腹水组为最高,其余3组含量相当;SAAG以门脉高压性腹水组和肝硬化伴自发性腹膜炎组为最高。结论联合检测腹水ADA、LDH、CEA及SAAG对腹水病因的鉴别诊断有重要的临床价值。

Objective To study the clinical significance of adenosine deaminase （ADA）, lactate dehydrogenase （LDH） , carcinoembryonic antigen （CEA） and serum-ascites albumin gradient （SAAG） in ascites of different etiologies. Methods The ascitic ADA, LDH, CEA and SAAG levels were measured in 139 patients with ascites. The receiver operating characteristic （ROC） curve was used to evaluate the value of 4 parameters in differential diagnosis of ascites. Results ADA level in tuberculous aseites group was the highest, followed by malignant ascites. LDH level in malignant ascites was the highest, followed by tuberculous ascites, portal hypertension group was the lowest. CEA was present at the highest level in malignant ascites and a similar level in other three groups. SAAG in ascites caused by portal hypertension or liver cirrhosis with spontaneous bacterial peritonitis was the highest. Conclusion Simultaneous detection of ADA, LDH, CEA and SAAG in ascites may play an important role in differential diagnosis for the causes of ascites.