腹水论文：腹水多指标的鉴别诊断意义及其与臌胀分型相关性研究.docVIP

腹水论文：腹水多项指标的鉴别诊断意义及其与臌胀分型相关性研究 【中文摘要】腹水是临床常见的病理性体征,其最常见的病因为肝硬化和恶性肿瘤,两者的治疗及预后大不相同,腹水脱落细胞学检查是诊断腹水性质的“金标准”,但其敏感性低,阴性结果并不能排除恶性腹水的可能。本研究选取腹水端粒酶、血清-腹水白蛋白梯度(SAAG)、CEA、CA125、CA19-9、CA153、LDH和ADA这8项指标,探讨其在鉴别肝硬化腹水和恶性腹水中的意义,并探讨各项腹水指标与臌胀辨证分型的相关性,为中医辨证分型寻找客观依据。方法：选择腹水患者72例,其中肝硬化腹水患者31例,恶性腹水患者41例,分别检测其腹水端粒酶、CEA、CA125、CA19-9、CA153、LDH、ADA和SAAG水平,进行统计分析；将腹水病例按中医臌胀相关分型标准,分为血臌29例,水臌22例,臌胀虚证21例,分析各指标在臌胀分型间的差异性；同时将31例肝硬化腹水患者按血瘀证标准分组,血瘀型组20例,非血瘀型组11例,结合Child-Pugh分级,分析各指标在两组间的差异性。结果：恶性腹水组的端粒酶、CEA、CA125、CA19-9、CA153和LDH显著高于肝硬化腹水组,SAAG显著低于肝硬化腹水组,差异均具有统计学意义(P0.05)。端粒酶和SAAG、端粒酶和LDH、SAAG和LDH分别进行联合检测时,敏感性和特异性分别为95.1%和80.6%,90.2%和90.3%,92.7%和83.9%,联合检测的敏感性高于单项检测。血臌组的SAAG水平高于水臌组(P0.05)。肝硬化血瘀型腹水组的SAAG及CA125水平高于肝硬化非血瘀型腹水组,差异有统计学意义(P0.05)。结论：端粒酶、SAAG、CEA、CA125、CA19-9、CA153和LDH对肝硬化腹水和恶性腹水具有鉴别诊断意义,腹水指标联合检测可提高腹水鉴别诊断的敏感性；SAAG可作为臌胀血臌分型的一个的指标；腹水端粒酶及CA153可能与臌胀虚证分型具有一定相关性；肝硬化血瘀型腹水组的SAAG、CA125水平较非血瘀型腹水组高,可能与血瘀型腹水组患者肝功能分级较差相关。 【英文摘要】Background:Ascites is the common pathologic sign in clinical practice. Two of the most common causes are liver cirrhosis and malignant tumors. The treatment and the prognosis of them are different.The cytopathology of ascites is the “gold standard” of differential diagnosis of ascites.But the sensitivity of the cytopathology is low and the negative result can’t exclude the diagnosis of malignant ascites.Purpose:In this research,we selected ascitic telomerase,serum-ascites albumin gradient (SAAG), CEA, CA125, CA19-9, CA153, LDH and ADA to investigate their differential diagnosis value of ascites. Meanwhile,we probed into the relation between the above index and syndrome differentiation of Tympanites,and tried to find out some objective evidences for TCM syndrome differentiation.Methods:Seventy-two patients with ascites were enrolled into two groups,31 in liver cirrhosis ascites group and 41 in malignant ascites group. Ascitic telomerase, CEA, CA125, CA19-9, CA153, LDH, ADA, albumin of serum and ascites were measured,and then the data was analysed by statistics.According to the s