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.doc

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.doc 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 【摘要】 目的 了解分别或联合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。 【关键词】 腹腔积液;血管内皮生长因子;糖类抗原199;糖类 抗原125;鉴别诊断 Abstract: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 malignant ascites. The concentrations of VEGF and CA125 in malignant ascites might have the certain functions in the differential diagnosis of the histological origins of the malignant ascites. Combined determinations of ascites VEGF, CA199 and CA125 levels might significantly enhance the sensitivity of malignant ascites diagnosis. Key words: ascites; vascular endothelial growth factor; CA199; CA125; differential diagnosis 不同疾病导致的腹腔积液其治疗方法和预后截然不同。故病因的 鉴别，尤其是良、恶性腹腔积液的鉴别极为重要。传统的腹腔积液 化验检查方法特异性和敏感性均较低。腹腔积液细胞学检查特异性 高,但敏感性低，故从腹腔积液中寻找理想的肿瘤标记物已成为当前 研究的热点。血管内皮生长因子(VEGF)是一种肿瘤生长、浸润和转 移的指标，而在恶性腹腔积液中糖类抗原199(CA199)、糖类抗原 125(CA125)的表达也明显升高。目前，分别检测此3项指标以鉴 别腹腔积液的良恶性的报道较多，而对联合检测的研究相对较少， 联合检测3项指标的临床意义也未完全阐明，故本研究分别应用酶 联免疫吸附法、电化学发光免疫法检测58例患者腹腔积液中的 VEGF、CA199和CA125，旨在观察不同病因腹腔积液中VEGF、 CA199和CA125的水平，探讨三者在良恶性腹腔积液鉴别诊断中的 价值，以及三者联合检测的临床意义。 1 资料和方法 1.1 研究对象 收集自2007年02月—2008年07月睢宁县人民医 院腹腔积液患者58例，男30例，女28例，平均年龄 (52.46?11.32)岁;其中良性腹腔积液组中肝硬化腹腔积液24例， 结核性腹腔积液8例;恶性腹腔积液组26例(卵巢癌8例、胃癌6 例、结肠癌5例、胰腺癌4例、肝癌2例、原发性腹膜癌1例)。全部病例均经细胞学检查、病理活检、B超及CT等检查确诊。良恶性腹腔积液患者的年龄、性别比较差异无显著性(P>0.05) 。 1.2 方法 1.2.1 标本采集 入院次日上午抽取腹腔积液，标本采集后，先以3000 r/min 离心10min，再取上清，按每次用量分装后立即置-20?冰箱冻存待测。 1.2.2 VEGF水平的测定 VEGF试剂盒购自深圳晶美生物有限公司，检测采用酶联免疫吸附法(ELISA法)，操作严格按照说明书进行。 1.2.3 CA199、 CA125水平的测定 所用检测仪器为ELECSY 2010全自动电化学发光免疫分析仪(罗氏公司)，并采用该公司生产的配套试剂。正常参考值:CA199<37 kU/L，CA125<35 kU/L。 1.3 统计学处理 实验数据采用SPSS 13.0软件进行统计，计量资料数据以?s表示，组间比较用方差分析，计数资料不同率间比较用χ2检验。检验水准:α=0.05。 2 结 果 2.1 不同类型腹腔积液VEGF、CA199、CA125水平的比较 见表1。恶性腹腔积液组VEGF、CA199浓度明显高于肝硬化腹腔积液组和结核性腹腔积液组(P均<0.01)，而肝硬化腹腔积液组和结核性腹腔积液组比较则无明显差异(P>0.05);恶性腹腔积液组CA125水平明显高于肝硬化腹腔积液组和结核性腹腔积液组，差异有显著性(P<0.01);结核性腹腔积液组CA125浓度高于肝硬化腹腔积液组(P<0.01)。表1 不同类型腹腔积液VEGF、CA199、CA125水平检测结果比较 与肝硬化腹腔积液组比较:?P<0.01;与结核性腹腔积液组比较:?P<0.01 2.2 不同组织来源恶性腹腔积液间VEGF、CA199、CA125的比较 见表2。其中卵巢癌患者的腹腔积液中VEGF、CA125水平高于胃癌、结肠癌和胰腺患者(P均<0.01)，而胃癌、结肠癌和胰腺癌组间比较，VEGF、CA125水平则无明显差异(P>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)。肝癌2例、原发性腹膜癌1例因病例数少，未进行统计学比较。表2 不同组织来源恶性腹腔积液组间VEGF、CA199、CA125的检测结果 分别与胃癌、结肠癌及胰腺癌组比较:?P<0.01 2.3 各指标(组合)对良恶性腹腔积液鉴别的价值 各检测指标对各型腹腔积液诊断的敏感性和特异性见表3 。据良性腹腔积液VEGF(?s)值上限，同时根据