联合检测生化、肿瘤标志物和血清腹水白蛋白梯度在腹水诊断中的价值  

Diagnosis value of combined detection of biochemical,tumor markers and serum ascites albumin gradient in ascites

作　　者：沈守军 胡明华[1] 高翼芳 王丽燕[1] 

机构地区：[1]嘉善县第一人民医院检验科,浙江嘉善314100

出　　处：《中国中西医结合消化杂志》2013年第10期517-519,共3页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：[目的]评价腺苷脱氢酶(ADA)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和血清-腹水白蛋白梯度(SAAG)单项和联合检测在鉴别良恶性腹水中的诊断意义,以提高对良恶性腹水诊断的准确率。[方法]95例诊断明确的腹水患者(其中良性组62例,恶性组33例)均接受ADA、LDH、CEA、CA19-9和SAAG检测,比较2组间水平差异,并计算单项和联合指标对恶性腹水诊断的敏感性、特异性、准确性和尤登指数。[结果]2组除LDH外,ADA、CEA、CA19-9和SAAG水平均差异有统计学意义(P<0.01)。单项指标分析,敏感度最高的指标为SAAG(84.85%),而CEA的特异性、准确性和尤登指数均为最高,分别为70.97%、73.68%和0.49。联合ADA、CEA和SAAG三项指标分析,则其敏感性、特异性、准确性和尤登指数分别为63.64%、88.71%、80.00%和0.43。[结论]ADA、CEA、CA19-9和SAAG中单项指标均存在敏感性、特异性不高或敏感性高但特异性差的不足,联合应用后其敏感性虽有所降低,但特异性和准确性均明显升高。[Objective]To evaluate the clinical significance of the differentiation diagnosis of adenosine dehydrogenase （ADA）, lactate dehydrogenase （LDH）, carcinoembryonic antigen （CEA）, carcinoembryonic 19-9 （CA19-9） and the serum ascites albumin gradient （SAAG） in ascites, so as to improve the accuracy rate of diagnosis of benign and malignant ascites. [Methods]Ascetic date from 95 patients with a identifiable cause were collected from March 2011 to October 2012, including 62 benign cases and 33 cases of malignant ascites. ADA, LDH,CEA, CA19-9 and SAAG were detected. The level differences of those indexes between benign group and malignant group were compared, and the sensitivity, specificity, accuracy and Youden~ s index of the individual and combined index for diagnosis of malignant ascites were calculated. [Results]Be- sides of LDH,the ADA, CEA, CA19-9 and SAAG levels were significantly different between two groups （P〈0.01）. In single index analysis, sensitivity index of SAAG was 84.85%, which was the highest. While the specificity, accuracy and Youden＇s index of CEA were the highest, which was 70. 97 %, 73.68 % and 0.49 respectively. Combined of ADA, CEA and SAAG, the sensitivity, specificity, accuracy and Youden＇ s index were 63.64%, 88.71%, 80%, and 0.43 respectively, l-Conclusion]Single index of ADA,CEA, CA19-9 and SAAG has the shortage of low sensitivity,specificity or high sensitivity but low specific. Although its sen- sitivity was decreased when combined detection,the specificity and accuracy were significantly elevated.

关 键 词：腹腔积液 鉴别诊断 肿瘤标志物 腺苷脱氢酶 白蛋白 

分 类 号：R442.5[医药卫生—诊断学]