肝硬化患者血清和腹水CA125升高

Elevation of serum and ascites CA125 levels in liver cirrhosis

目的:研究肝硬化患者血清和腹水 CA125升高的情况、原因及临床意义.方法:共有70例患者入选,分成3组:组1(GroupⅠ),肝硬化伴或不伴腹水患者30例,组2(GroupⅡ),消化系统肿瘤伴或不伴腹水患者30例,组3(GroupⅢ),除肝硬化外其他良性疾病引起的腹水患者10例.检测所有患者血清CA125(15例患者同时检测腹水 CA125),并与病因、腹水、Child 分级等指标作相关分析.同时检测 AFP、CEA 和CA19-9等肿瘤标记物.结果:87%的 GroupⅠ患者存在血清 CA125异常升高,伴腹水的患者血清 CA125异常发生率显著高于不伴腹水的患者(95%vs 38%,P<0.01).血清 CA125的水平与 Child-Pugh 评分相关(但不具显著性.r=0.38,P=0.06),而与肝硬化的病因无关.GroupⅡ伴腹水和 GroupⅢ的患者血清CA125明显升高,但 GroupⅠ伴腹水患者、GroupⅡ伴腹水患者和 GroupⅢ患者之间的血清 CA125水平无显著差异(P>0.05),分别为275±175kU/L、368±190kU/L 和396±287kU/L,均显著高于 GroupⅠ和 GroupⅡ不伴腹水的患者的血清 CA125水平(分别为72±83kU/L 和83±42kU/L,P<0.05).血清 CA125显著低于腹水 CA125(198±108 kU/L vs 460±234 kU/L),二者呈线性相关(r=0.58,P=0.026);90%的恶性腹水患者血清 CA125的升高伴有其他肿瘤标记物的异常,而良性腹水患者极少伴其他指标的异常(仅2%,P<0.01).38例患者仅血清 CA125异常,其中有36例(95%)为良性腹水.结论:肝硬化患者血清 CA125的异常升高很常见,其水平与腹水有关,也可能与肝功能不全有关,但与腹水的病因、良恶性等无关.血清 CA125可能来源于腹水血清 CA125单项异常多提示良性、而非恶性疾病.

AIM:To evaluate the range of serum and ascitic cancer antigen(CA)125 levels in patients with liver cirrhosis and to explore possible factors associated with CA 125 elevation. METHODS:A total of 70 patients were studied.Group Ⅰ consisted of 30 patients with liver cirrhosis with or without ascites.Group Ⅱ consisted of 30 patients with digestive malignant tumors with or without asictes.And group Ⅲ consisted of 10 patients with benign(but not cirrhotic)ascites. CA 125 levels were measured in sera of all the patients and also simultaneously in ascitic fluids of 15 patients. RESULTS:Serum CA125 levels in 87% patients from group Ⅰ were elevated,especially in those with ascites(95% vs 38% in patients without ascites,P<0.01)irrespective of the etiology of cirrhosis.Serum CA 125 levels were correlated with Child-Pugh scores(r=0.38)but it was marginally significant(P=0.06).All the patients with ascites from group Ⅱ and group Ⅲ had elevated serum CA 125 levels. There was no difference in serum CA 125 levels among patients with ascites from group Ⅰ(275±175 kU/L),group Ⅱ (368+190 kU/L) and group Ⅲ(396±287 kU/L),neither did ascitic CA 125 levels(P>0.05),but serum CA 125 levels were significantly higher than those of patients without ascites from groupⅠ(72±83 kU/L)and groupⅡ(83±42 kU/L). The levels of serum CA 125 were lower than,but correlated with that or ascites CA 125(198±108 kU/L vs460±234 kU/L, r=0.58,P=0.026).The elevation of serum CA 125 in malignant ascites was more often accompanied with abnormalities of other tumor markers compared with that in benign ascites (90% vs6%,P<0.01).Among the 38 patients with only serum CA125 elevation but not accompanied with a rise of other tumor markers,36(95%)were diagnosed as benign ascites. CONCLUSION:The elevation of serum CA 125 is common in liver cirrhosis patients.It is correlated with the amount of ascites,and possibly insufficiency of liver function.Serum CA 125 probably derives from ascites.It usually predicts benign disease if the elevation of serum or ascites CA 125 is not accompanied with a rise of other tumor markers.