联合检测腹水、血清肿瘤标志物及其比值对鉴别良恶性腹水的诊断价值  

Differential diagnostic value of simultaneous determination of tumor markers in ascitic fluid and serum and their ratios for differentiation of benign from malignant ascites

作　　者：谷欢[1] 邓翔宇[1] 严璐[1] 张桂英[1] 

机构地区：[1]中南大学湘雅医院消化内科,湖南长沙410008

出　　处：《中国现代医学杂志》2011年第14期1595-1599,共5页China Journal of Modern Medicine

摘　　要：目的评价同时测定腹水、血清中肿瘤标志物及其腹水/血清(F/S)比值对良恶性腹水的鉴别诊断价值。方法回顾性分析95例渗出性腹水患者(恶性52例,良性43例)腹水、血清中肿瘤标志物AFP、CEA、CA19-9和CA125浓度及其F/S比值的情况。结果①恶性腹水组中腹水CEA、CA19-9、CA125和血清AFP、CEA、CA19-9测得值分别高于良性腹水组(P<0.001)。②根据受试者工作特性曲线(receiver operating charac-teristic,ROC)分析,结果显示CEA和CA19-9对鉴别良恶性腹水时有较高的诊断价值,而AFP对鉴别良恶性腹水的诊断价值较小,CA125无鉴别诊断价值。③CEA、CA19-9及其F/S比值>1.76的联合诊断恶性腹水的敏感性、特异性和准确性为94.2%、90.7%和92.6%,与单项肿瘤标志物腹水浓度测定或两种肿瘤标志物联合检测相比,敏感性和准确性有显著提高(P<0.01)。结论腹水CEA和CA19-9对良恶性腹水的鉴别诊断价值高,腹水CA125在鉴别良恶性腹水时无诊断价值。联合检测腹水肿瘤标志物CEA、CA19-9及其F/S比值能显著提高对恶性腹水诊断的敏感性和准确性。【Objective】 To evaluate the clinical diagnostic value of simultaneous determination of tumor markers in fluid and serum and their ratio（F/S） to patients with benign or malignant ascites.【Methods】 Retrospective analyzed the concentrations of tumor markers AFP,CEA,CA19-9,CA125 in fluid and serum and their ratio from 95 patients with ascites due to various causes（malignant 52,benign 43）.【Results】 The levels of ascitic fluid CEA,CA19-9,CA125 and the blood serum AFP,CEA,CA19-9 in patients with malignant ascites were significantly higher than those in patients with benign ascites（P 0.001）.According to the ROC curve,the under-curve area of fluid AFP,CEA,CA19-9 and CA125 were 0.510,0.825,0.773 and 0.500.It showed that CEA and CA19-9 could be used for differential diagnosis between malignant and benign ascites.AFP had a little differential diagnostic value and CA125 had no value.The sensitivity,specificity and diagnostic accuracy of the combined detection of these two tumor markers and their F/S ratios were 94.2%,90.7% and 92.6%.The diagnostic sensitivity and accuracy were obviously improved（P 0.01）.【Conclusions】 The fluid CEA and CA19-9 were more valuable than AFP for differentiation of benign from malignant ascites,CA125 had no value for differentiation of benign from malignant ascites.The diagnostic sensitivity and accuracy could be significantly increased by simultaneous determination of the concentration of CEA,CA19-9 in fluid and their F/S ratio.

关 键 词：腹水 恶性 良性 鉴别诊断 肿瘤标志物 

分 类 号：R572[医药卫生—消化系统]