肿瘤标志物对良恶性腹水鉴别诊断价值的探讨

Value of Tumor Markers in the Differential Diagnosis of Malignancy-related and Non-malignant Ascites

目的 探讨鉴别良恶性腹水的新方法。方法 比较几组患者 15 2例血清及腹水肿瘤标志物 (AFP、CEA、CA19-9及CA12 5 )的情况。结果 恶性腹水组血清AFP、CEA、CA19-9及CA12 5水平较良性腹水组显著升高 (P <0 0 1)。血清AFP、CEA、CA19-9及CA12 5诊断恶性腹水的敏感性分别为 75 0 % ,73 8% ,63 6%及 66 7% ,特异性分别为 86 4% ,77 6% ,88 4%及74 1%。在鉴别结核、肝硬化与恶性腹水时 ,以CA12 5≥ 40 0KU/L为阳性界值更为适当 ,可提高诊断的特异性及准确性。以AFP≥40 0ng/ml为阳性界值可提高诊断原发性肝癌的特异性。血清AFP及CEA联合检测可提高诊断恶性腹水的敏感性至 94 7%。结论检测肿瘤标志物 (AFP、CEA、CA19-9及CA12 5 )有助于良恶性腹水的鉴别诊断 ,血清AFP及CEA联合检测可提高诊断恶性腹水的敏感性。

Objective To explore the new way of the differential diagnosis of malignancy-related and non-malignant ascites.Methods 152 patients included 66 cases of liver cirrhosis, 21 cases of tuberculousperitonitis, 38 cases of hepatocellular carcinoma and 27 cases of other malignant tumors with ascites were studied. The levels of tumor markers (AFP, CEA, CA19-9 and CA125) in sera and ascites were measured.Results The diagnostic sensitivity of AFP, CEA, CA19-9 and CA125 in the malignancy-related ascites were 75 0%, 73 8%, 63 6% and 66 7%, respectively. And the specificity were 86 4%, 77 6%, 88 4% and 74 1%, respectively. The level of serum AFP, CEA, CA19-9 and CA125 were remarkably higher in malignancy-related ascites than that in non-malignant ascites(P<0 01).Between tuberculous or cirrhotic ascites and maligancy-related ascites ,was distinguished by 400KU/L of CA125 cut off value.It can increase the diagnostic specificity and accuracy. At the cut off value of 400ng/ml of AFP, the diagnostic specificity of hepatocellular carcinoma was improved.Detective sensitivity of serum AFP combined with CEA was increased to 94 7%.Conclusions The findings suggest that it is helpful to the differential diagnosis of malignancy-related and non-malignant ascites by detecting tumor markers (AFP, CEA, CA19-9 and CA125). The combined assay of serum AFP and CEA can enhance the diagnostic sensitivity of maligancy-related ascites.