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目的 探讨鉴别良恶性腹水的新方法。方法 比较几组患者 15 2例血清及腹水肿瘤标志物 (AFP、CEA、CA19-9及CA12 5 )的情况。结果 恶性腹水组血清AFP、CEA、CA19-9及CA12 5水平较良性腹水组显著升高 (P <0 0 1)。血清AFP、CEA、CA19-9及CA12 5诊断恶性腹水的敏感性分别为 75 0 % ,73 8% ,63 6%及 66 7% ,特异性分别为 86 4% ,77 6% ,88 4%及74 1%。在鉴别结核、肝硬化与恶性腹水时 ,以CA12 5≥ 40 0KU/L为阳性界值更为适当 ,可提高诊断的特异性及准确性。以AFP≥40 0ng/ml为阳性界值可提高诊断原发性肝癌的特异性。血清AFP及CEA联合检测可提高诊断恶性腹水的敏感性至 94 7%。结论检测肿瘤标志物 (AFP、CEA、CA19-9及CA12 5 )有助于良恶性腹水的鉴别诊断 ,血清AFP及CEA联合检测可提高诊断恶性腹水的敏感性。
Objective To explore a new method to identify benign and malignant ascites. Methods A total of 152 cases of serum and ascitic tumor markers (AFP, CEA, CA19-9 and CA12 5) were compared among several groups of patients. Results Serum levels of AFP, CEA, CA19-9 and CA12 5 in malignant ascites group were significantly higher than those in benign ascites group (P <0.01). The sensitivity of serum AFP, CEA, CA19-9 and CA125 in the diagnosis of malignant ascites were 75.0%, 73.8%, 63.6% and 66.7%, respectively, and the specificity were 86.4%, 77.6%, 88.4% And 74 1%. In the identification of tuberculosis, cirrhosis and malignant ascites, CA12 5 ≥ 40 0KU / L positive cutoff is more appropriate, can improve the specificity and accuracy of diagnosis. To AFP ≥ 40 0ng / ml as a positive cut-off value can improve the specificity of diagnosis of primary liver cancer. Serum AFP and CEA combined detection can improve the sensitivity of malignant ascites diagnosis to 94 7%. Conclusion The detection of tumor markers (AFP, CEA, CA19-9 and CA12 5) is helpful for the differential diagnosis of benign and malignant ascites. The combined detection of serum AFP and CEA can improve the sensitivity of diagnosis of malignant ascites.