血管内皮生长因子、糖类抗原199和糖类抗原125对腹腔积液良恶性的鉴别价值

目的了解分别或联合检测腹腔积液中血管内皮生长因子（VEGF）、糖类抗原199（CA199）和CA125对良、恶性腹腔积液的鉴别诊断价值，提高对腹腔积液的诊断水平。方法收集各种类型腹腔积液共58例，采用酶联免疫吸附法检测VEGF含量，电化学发光法检测CA199、CA125含量。计算各指标独立或联合鉴别诊断腹腔积液的敏感性、特异性和准确性。结果恶性腹腔积液组VEGF、CA199、CA125含量明显高于良性腹腔积液组（P均〈0．01），结核性腹腔积液组CA125含量高于肝硬化腹腔积液组（P〈0．01）。卵巢癌患者的腹腔积液中VEGF、CA125水平高于胃癌、结肠癌和胰腺癌（P均〈0．05），胰腺癌患者腹腔积液中CA199水平高于另外3类，但无明显差异（P〉0．05）。VEGF诊断恶性腹腔积液的敏感性、特异性和准确性分别为84．6％、84．4％和84．5％；CA199的敏感性、特异性和准确性分别为61．5％、78．1％、70．7％；CA125的敏感性、特异性和准确性分别为69．2％、56．3％、62．1％；而联合检测VEGF、CA199和CA125的敏感性、特异性和准确性分别为92．3％、81．3％、86．2％，其中敏感性明显高于单独检测CA199（P〈0．01）或CA125（P〈0．01）。结论腹腔积液中VEGF、CA199、CA125测定有助于良恶性腹腔积液的鉴别诊断；恶性腹腔积液中VEGF、CA125的含量对恶性腹腔积液的组织来源可能有一定的鉴别诊断作用；联合检测腹腔积液中的VEGF、CA199、CA125水平，可明显提高诊断恶性腹腔积液的敏感性。

The value of combined detections of VEGF, CA199 and CA125 in differential diagnosis between benign and malignant ascites

Objective To investigate the value of individual or combined detections of vascular endothelial growth factor （VEGF）, CA199 and CA125 in differential diagnosis between benign and malignant ascites, so as to elevate the levels of ascites diagnosis. Methods 58 cases of various ascites were collected. VEGF levels were detected by enzyme -linked immunosorbent assay （ELISA） and contents of CA199 and CA125 were determined by electrochemiluminescence method. The sensitivity, specificity and accuracy of individual or combined detections of VEGF, CA199 and CA125 in differential diagnosis were calculated. Results The levels of VEGF, CA199 and CA125 in malignant ascites were significantly higher than benign ascites （P 〈 0.01 ）. The CA125 levels in tuberculous ascites group were significantly higher than cirrhotic ascites group （P 〈 0.01 ）. The levels of VEGF and CA125 in malignant ascites of ovarian carcinoma group were obviously higher than those of gastric carcinoma, colorectal carcinoma or pancreatic cancer groups （ P 〈 0. 05）. The levels of CA199 in malignant ascites of pancreatic cancer patients were higher than the other three groups, while there was no obvious difference （P 〉 0. 05）. The rate of sensitivity, specificity and accuracy of VEGF in the diagnosis of the malignant ascites was 84.6%, 84.4% and 84.5%, respectively. The rate of sensitivity, specificity and accuracy of CA199 in the diagnosis of the malignant ascites was 61.5% , 78.1% and 70.7% , respectively. While the rate of sensitivity, specificity and accuracy of CA125 was 69.2% , 56.3% and 62.1% , respectively. Combined determinations of VEGF, CA199 and CA125 showed that the rate of sensitivity, specificity and accuracy was 92.3% ,81.3% and 86.2% , respectively, of which the sensitivity was apparently higher than that of determinations of CA199 （P 〈 0.01 ） or CA125 （P 〈0.01 ） alone. Conclusion The determination of VEGF, CA199 and CA125 levels in ascites might contribute to differentiate benign ascites from malig