腹水-血清中肿瘤标志物梯度及比值在结核、恶性腹水中的诊断价值  

Value of measurement of gradient and ratio of ascitesserum tumor markers in differential diagnosis of tuberculous ascites and malignant ascites

作　　者：余韬[1] 舒徐[1] 陈幼祥[1] 李国华[1] 朱勇[1] 周小江[1] 吕农华[1] 

机构地区：[1]南昌大学第一附属医院消化内科,江西省南昌市330000

出　　处：《世界华人消化杂志》2016年第30期4216-4222,共7页World Chinese Journal of Digestology

摘　　要：目的探究腹水血清中肿瘤标志物的梯度、比值对结核性及恶性腹水的鉴别意义.方法将诊断明确的63例腹水患者,分成两组,其中恶性组31例,结核组32例,同步检测血清腹水中肿瘤标志物含量.计算腹水与血清中同项肿瘤标志物梯度、比值,并与单纯测定标志物含量进行比较分析.结果血清腹水中CEA、CAl99的恶性组阳性率显著高于结核组(P<0.01),CA125、甲胎蛋白(α-fetoprotein,AFP)阳性率差异均无统计学意义(P>0.05).肿瘤标志物腹水与血清比值分析:CA125、CA199、CEA差异均有统计学意义,其中CA125差异具有显著统计学意义(P<0.01),腹水一血清梯度分析:CA125、CEA、CA199差异均具有显著统计学意义(P<0.01);腹水与血清中AFP比值、梯度差异均无统计学意义(P>0.05).结论若以CA125比值>2.16,梯度>264.05 ng/mL;CEA比值>4.8,梯度>23.05 ng/mL;CA199比值(>0.96),梯度>-0.20 ng/mL为阳性界值时,上述3项肿瘤标志物的梯度和比值在非肝癌性腹水中的诊断价值高于单纯分析其标志物含量.对于结核性腹水和恶性腹水鉴别有重要的意义,也为诊断提供新思路.AIM To assess the value of measurement of the gradient and ratio of ascites-serum tumor markers in the differential diagnosis of tuberculous ascites and malignancy-related ascites.METHODS Sixty patients with ascites were divided into two groups,namely,31 cases of malignant ascites and 31 cases of tuberculous ascites.Tumor markers in serum and ascites were simultaneously detected to calculate and compare the gradient and ratio of serum-ascites tumor markers between the two groups.RESULTS The positive rates of CEA and CA199 in the malignant group were significantly higher than those of the tuberculosis group（P 0.01）.The positive rates of CA125 and α-fetoprotein（AFP）showed no significant difference between the two groups（P 0.05）.Ratio analysis of tumor markers in ascites and serum revealed that CA125,CA199,and CEA ratios were statistically significant between the two groups,with CA125 ratio having the most significant difference（P 0.01）.Ascites-serum gradient analysis showed that CA125,CEA,and CA199 gradients were significantly different between the two groups（P 0.01）.The ratio and gradient of AFP were not significantly different between the two groups（P 0.05）.CONCLUSION At the cutoff values of CA125 ratio 2.16,CA125 gradient 264.05 ng/mL,CEA ratio 4.8,CEA gradient 23.05 ng/mL,CA199 ratio 0.96,and CEA gradient -0.20 ng/mL,the diagnostic value of combining the gradients and ratios of the three tumor markers are more helpful to distinguish tuberculous ascites and non-liver cancer ascites than any of the three markers alone.

关 键 词：结核性腹水 恶性腹水 肿瘤标志物 CEA CA125 甲胎蛋白 CA199 梯度 比值 

分 类 号：R730.43[医药卫生—肿瘤] R52[医药卫生—临床医学]