肿瘤标志物联合检测对良、恶性腹水鉴别诊断价值

目的探讨联合测定血清和腹水中3种肿瘤标志物CEA、CA19-9和CA50水平及其腹水/血清比值(F/S)对良、恶性腹水鉴别诊断的价值。方法明确诊断的腹水患者180例,其中男性76例,女性104例;年龄25～78岁,平均年龄54.99岁。61例良性和119例恶性腹水患者同时采血和抽取腹水,采用电化学发光法测定CEA、CA19-9和CA50。结果腹水肿瘤标志物的水平高于血清正常上限值(CEA>5μg/L、CA19-9>37kU/L、CA50>20mg/L)时,良性腹水的F/S比值都<1.2,而恶性腹水的绝大多数F/S比值>1.2。腹水CEA、CA19-9和CA50的上述上限值结合F/S比值>1.2,诊断灵敏度分别为63.9%、59.6%和74.6%,皆显著高于单纯的腹水浓度和F/S比值的灵敏度(P<0.01)。3项联合诊断灵敏度达93.8%,特异度100%。结论与单纯血清或腹水中浓度测定相比,同时测定肿瘤标志物CEA、CA19-9和CA50的腹水浓度和F/S比值能显著提高诊断的灵敏度和特异度,对良、恶性腹水的鉴别诊断具有较大的价值。

Combined detection of tumor markers in differential diagnosis of benign and malignant ascites

Objective To observe the role of combined detection levels of 3 tumor markers CEA,CA19-9 and CA50 of serum and ascites and the ratio of ascites to serum（F/S） in differential diagnosis of benign and malignant ascites.Methods A total of 180 ascites patients were enrolled,male 76,female 104,aged 25-78 years old,mean age 54.99 years old;the serum and ascites of 61 benign cases and 119 malignant were obtained,the level of CEA,CA19-9 and CA50 were measured by electrochemical luminescence.Results The ascites tumor marker level was higher than the upper limit of normal serum（CEA 5 μg/L,CA19-9 37 kU/L,CA50 20 mg/L）,the benign ascites F/S ratio were 1.2,and the malignant ascites 1.2.The diagnostic sensitivity was 63.9 %,59.6 % and 74.6 % respectively,which was significantly higher than simple ascites concentration and F/S ratio（P 0.01）.The sensitivity of 3 combined diagnostic was 93.8 % and the specificity was 100 %.Conclusion It is demonstrated that compared with simple detection of serum or ascites concentration of CEA,CA19-9 and CA50,it could significantly improve the diagnostic sensitivity and specificity to measure of the concentration of tumor markers CEA,CA19-9 and CA50 in ascites and F/S ratio simultaneously,which has the great value in differential diagnosis of benign and malignant ascites.