血清及腹水肿瘤标志物对良恶性腹水的鉴别诊断价值

Diagnostic Performance of Serum/Ascitic Tumor Markers for Benign versus Malignant Ascites

目的评价血清及腹水肿瘤标志物对良恶性腹水的诊断价值。方法回顾性分析435例患者临床资料,检测血清、腹水肿瘤标志物,并绘制肿瘤标志物受试者工作特征曲线(receiver operating characteristic curve,ROC)。结果设定肿瘤标志物的临界值,恶性腹水组癌胚抗原(CEA)、CA19-9、CA15-3高于临界值的患者比例明显高于良性腹水组(均P<0.05),而血清和腹水CA12-5无明显差异;腹水肿瘤标志物的诊断效能优于血清肿瘤标志物,其中腹水CEA诊断价值最高;与单一肿瘤标志物相比,联合检测腹水肿瘤标志物(CEA+CA19-9+CA15-3)其诊断价值更高。结论联合检测CEA、CA19-9、CA15-3对于良、恶性腹水的鉴别诊断有重要的价值,尤其是腹水中肿瘤标志物,使用ROC曲线可以更客观地评价其诊断价值。

Objective To evaluate the implication of serum/ascite tumor markers in differentially diagnosing benign or ma- lignant ascites. Methods The clinical data of 435 patients with ascites were retrospectively analyzed. All the patients had under- gone abdominal paracentesis. The concentration of tumor markers in the serum and ascites was detected,and the ROC curves of tumor markers were drawn. Results With the cut-off points of tumor markers predetermined, it was found that the number of patients having the levels of CEA,CA19-9 and CA15-3 higher than the cut-off values in the malignant ascite group was signifi cantly greater than that in the benign ascite group（P^0.05）. There was no significant difference in the CA12-5 level between the malignant group and the benign group. The tumor markers in the ascitic fluid had a better diagnostic performance than those in the serum. Among the tumor markers,the ascitic CEA had the best diagnostic efficacy~ the combined ascitic tumor markers （CEA＋CA19-9＋CA15-3） yielded better diagnostic performance in comparison with single tumor marker. Conclusion Com- bined detection of ascetic tumor markers（CEA＋ CA19-9 q-CA15-3）possesses diagnostic value in the differentiation of benign from maliunant ascites. ROC curve can evaluate the diagnostic value more objectively.