临床诊断与鉴别诊断结核性与恶性腹水的研究

目的：评价应用阿拉伯糖甘露糖脂IgG抗体（LAM—IgG）、结核杆菌DNA（TB-DNA）、腺苷脱氨酶（ADA）、癌胚抗原（CEA）和癌胚抗原信使核糖核酸（CEA—mRNA）鉴别诊断结核性与恶性腹水的价值。方法：以37例结核性腹水（结核组）和37例恶性腹水（恶性组）为研究对象，分别采用斑点免疫金渗滤试验法检测LAM-IgG、酶学反应终点法检测ADA、磁酶免法检测CEA、PCR法检测TB—DNA和CEA—mRNA。结果：结核组与恶性组检测LAM-IgG、TB-DNA、ADA、CEA和CEA-mRNA结果的差别均具有显著性（P〈0．01），各指标的特异性、敏感性、阳性预测值和阴性预测值分别为：①诊断结核性腹水：LAM-IgG91．9％、59．5％、88．0％和69．4％，TB-DNA97．3％、70．3％、96．3％和76．6％，ADA（〉33U／L）86．5％、81．1％、85．7％和82．0％；②诊断恶性腹水：CEA94．6％、56．8％、91．3％和68．6％，CEA—mRNA91．9％、81．1％、90．9％和82．9％，ADA（〈33U／L）81．1％、86．5％、82．1％和85．7％。结论：LAM-IgG、TB-DNA和CEA、CEA—mRNA指标分别在诊断结核性腹水和恶性腹水方面具有较高的应用价值，ADA诊断两种腹水的特异性较低但敏感性较高，综合分析这5个指标的检测结果对鉴别诊断结核性与恶性腹水具有较高的应用价值。

STUDY ON DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF TUBERCULOUS AND MALIGNANT ASCITES

Objective：To evaluate the significance of detecting LAM-IgG,TB-DNA,ADA,CEA and CEA- mRNA in differential diagnosis of tuberculous and malignant ascites.Methods：37 cases of tuberculous and malignant ascites were applied in this study.Dot immunogold filtration assay was used to detect LAM-IgG, terminal reaction of enzymology to detect ADA,magnetic antibody immunoenzymetric assay to detect CEA and PCR to detect TB-DNA and CEA-mRNA.Results：There had obvious differences about the detecting results of these 5 indexes between tuberculous ascites and malignant ascites （P 〈 0.01）.The specificity,sensitivity, positive forecast and negative forecast of each index were：（1）LAM-IgG,TB-DNA and ADA （ADA 〉 33U/L） of tuberculous ascites were 91.9%,59.5%,88.0% and 69.4%,97.3%,70.3%,96.3% and 76.6%,86.5%,81.1%, 85. 7% and 82.0% .（2）About malignant ascites,CEA,CEA-mRNA and ADA （ADA 〈 33U/L）were 94.6%,56.8%, 91. 3% and 68.6%,91.9%,81.1%,90.9% and 82.9%,81.1% 86.5%,82.1% and 85.7% respectively.Conclusions： LAM-IgG,TB-DNA,CEA and CEA-mRNA have higher specificity and sensitivity in diagnosis of tuberculous and malignant ascites respectively;ADA has higher sensitivity but lower specificity in differential diagnosis of tuberculous and malignant ascites.Synthetical analysis these 5 indexes has higher value in diagnosis and differential diagnosis of tuberculous and malignant ascites.