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

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（CAl9—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。3-法395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。

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

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.