腹水CEA和CA199对腹水细胞学未确定恶性腹水的诊断价值  

Diagnostic value of ascitic fluid CEA and CA199 in uncertain malignant ascites

作　　者：胡凯风[1] 许建明[2] 夏先明[1] 杨冰冰[1] 周菊[1] 李素文[1] 

机构地区：[1]安徽医科大学第四附属医院消化内科,合肥230022 [2]安徽医科大学第一附属医院消化内科

出　　处：《国际消化病杂志》2012年第6期372-375,382,共5页International Journal of Digestive Diseases

摘　　要：目的评价腹水CEA和CA199对腹水细胞学未确定恶性腹水的辅助诊断价值。方法连续收集2009年7月至2011年1月住院的86例诊断明确的腹水患者,其中恶性、良性腹水患者各43例,利用腹水CEA、CA199受试者工作特征曲线(ROC曲线),分别计算腹水CEA、CA199对腹水细胞学未确定恶性腹水诊断的灵敏度和特异度。结果 86例腹水患者中,恶性腹水患者的腹水CEA和CA199显著升高,与良性腹水患者比较,两者的差异有统计学意义(P<0.05)。43例恶性腹水患者中,腹水细胞学诊断的灵敏度为20.9%,特异度为100%。腹水CEA和CA199的ROC曲线下面积分别为0.86和0.76。以CEA>2.5 ng/ml和CA199>20 U/ml为阳性界值,腹水CEA、CA199单独诊断恶性腹水的灵敏度和特异度分别为69.7%和90.6%,55.8%和90.6%,腹水CEA、CA199诊断腹水细胞学未确定恶性腹水的灵敏度分别为67.6%和58.8%,两者联合检测诊断腹水细胞学未确定恶性腹水灵敏度提高至76.5%。结论腹水脱落细胞学对恶性腹水诊断特异度高,但灵敏度低。对于腹水细胞学未确定恶性腹水,腹水CEA和CA199具有较高的辅助诊断价值。Objective To study the diagnostic value of ascitic fluid CEA and CA199 in uncertain malignant ascites. Methods Collections of ascitic fluid date from 86 patients from July 2009 to January 2011 with an identifiable cause of ascites, including43 with malignant ascites, 43 with benign ascites. The sensitivity and specificity of ascitic fluid CEA, CA199 were calculated in uncertain malignant ascites by building receiver operating characteristic curve of ascitic fluid CEA, CA199. Results In 86 patients with ascites, ascitic fluid CEA and CA199 were significantly higher in malignant ascites, compared with benign ascites, which were significantly different （P〈0.05）. In 43 patients with malignant ascites, the diagnostic sensitivity and specificity of ascitic fluid cytology were 20.9% and 100%. The area under the ROC curve of ascitic fluid CEA and CA199 were 0.86 and 0.76. Using CEA〉2.5 ng/ml and CA199%〉20 U/ml as positive cutoff values, the sensitivity and specificity to diagnose malignant ascites were 69. 7% and 90. 6%, 55. 8% and 90.6% respectively. In uncertain malignant ascites, the diagnostic sensitivity were 67.6% in CEA and 58.8% in CA199. The diagnostic sensitivity was improved to 76. 5% by the combination of CEA and CA199 in uncertain malignant aseites. Conclusions Ascitic fluid cytology has high specificity in the diagnosis of malignant ascites , but the sensitivity is low. In the uncertain malignant ascites, ascitic fluid CEA and CA199 have a higher auxiliary diagnostic value.

关 键 词：恶性腹水 腹水细胞学 CEA CA199 

分 类 号：R730.4[医药卫生—肿瘤]