多项指标联合检测腹水临床意义研究  

Clinical significance of multiple biomarker detection of ascites.

作　　者：鲁伟[1] 崔光莹[1] 刁宏燕[1] 

机构地区：[1]浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州310003

出　　处：《中国实用内科杂志》2011年第4期285-287,共3页Chinese Journal of Practical Internal Medicine

基　　金："艾滋病和病毒性肝炎等重大传染病防治"科技重大专项"十一五"计划(编号:2009ZX10004-3092008ZX10002-007);新世纪优秀人才支持计划(课题号:NCET-09-0686);钱江人才(课题号:2010R10061)

摘　　要：目的探讨肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、血管内皮生长因子(VEGF)及C-反应蛋白(CRP)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)在肝硬化合并自发性腹膜炎(SBP)、恶性肿瘤、肾性腹水中的水平及临床意义。方法收集浙江大学医学院附属第一医院2008—2009年收集的26例SBP、31例恶性肿瘤、12例肾病患者的腹水,采用酶联免疫吸附法(ELISA)检测其中IL-6、TNF-α、VEGF的生物学活性,雅培Ci8200全自动生化、免疫分析仪检测CRP、CEA、LDH等指标,并对结果进行比较分析。结果 SBP腹水TNF-α、IL-6、CRP高于肾性和恶性腹水组,差异有统计学意义(P均<0.05);恶性腹水组VEGF、CEA、LDH高于肾性腹水组和SBP组,差异有统计学意义(P均<0.01);恶性腹水组CRP浓度高于肾性腹水组,差异有统计学意义(P<0.01);联合VEGF、CEA、LDH诊断恶性腹水的敏感性和特异性分别为90.3%和76.3%;联合TNF-α、IL-6、CRP诊断SBP腹水敏感性和特异性分别为96.2%和72.1%。结论腹水中TNF-α、IL-6、CRP的升高有助于SBP的诊断,腹水中VEGF、CEA、LDH的浓度对鉴别良、恶性腹水具有一定临床价值。Objective To study the levels and clinical significance of cytokines,C-reactive protein （CRP）, carcinoembryonic antigen （CEA） ,lactate dehydrogenase （LDH） in ascites from patients with spontaneous bacterial peritonitis （SBP） complicated liver cirrhosis, malignant tumors, or kidney disease. Methods In 69 patients （26 with SBP,31 with malignant tumors, 12 with kidney disease） registered to First Affiliated Hospital of Zhejiang University Medical College, the levels of IL-6, TNF-α and VEGF were measured by enzyme-linked immunosorbent assay （ELISA）, and CRP, CEA, LDH and other biomarkers were detected by Abbott Ci8200 automatic analyzer. Results The levels of TNF-c~, IL-6 and CRP in SBP ascites were significantly higher than those in nephrogenic or malignant ascites （P 〈 0. 01 or P 〈 0. 05 ）. Compared with SBP and nephrogenic ascites group, the levels of VEGF,CEA and LDH in patients with malignant tumors were significantly increased （all P 〈0. 01 ）. The level of CRP in malignant ascites was significantly higher than that in nephrogenic ascites （ P 〈 0.01 ）. The sensitivity and specificity were 90. 3% and 76. 3% ,respectively,for combined detection of VEGF,CEA and LDH in diagnosis of malignant ascites;96. 2% and 72. 1% for combined detection of TNF-c~,IL-6 and CRP in diagnosis of SBP ascites. Conclusion The elevated levels of TNF-α,IL-6 and CRP in ascites might favor identification of SBP. Measurement of VEGF,CEA and LDH in ascites may contribute to differential diagnosis between benign and malignant asc＇ites.

关 键 词：腹水 自发性腹膜炎 乳酸脱氢酶 血管内皮生长因子 C-反应蛋白 白介素-6 肿瘤坏死 因子-α 

分 类 号：R5[医药卫生—内科学]