腹水病因临床分析及腹水指标检测对腹水鉴别诊断的价值探讨

发布时间：2018-10-31 19:59

【摘要】：目的：腹水由于起病急缓不一,其腹水量各异,其临床症状亦千差万别。引起腹水的病因错综复杂,有相关文献报道表明恶性肿瘤为腹水的常见病因,但也有部分资料表明肝硬化的比例较高,Bud-Chiari综合征、恶性间皮瘤、肝小静脉闭塞症等病因是导致腹水的少见原因。不同病因腹水的治疗方法及预后迥然不同,对腹水病因的明确至关重要,如何选择准确的诊断方法是临床工作者亟待解决的问题。临床工作中常用于明确腹水病因的检查有：腹水常规、生化、肿瘤标志物、脱落细胞学、内镜、影像学、腹腔镜等手段。对恶性腹水诊断具有决定意义的检查为腹水脱落细胞学检测,尽管其特异性可达100%,但由于受经验、腹水肿瘤细胞脱落数量、肿瘤细胞破坏程度、复杂细胞成分、腹水脱落细胞学检查的次数、不典型脱落细胞学形态等多方面因素的影响,其阳性率偏低。为寻找具有高度敏感度和特异度的指标,本研究通过对腹水临床特点、腹水生化及肿瘤标志物指标的探讨,为广大临床工作者在腹水病因分析方面尤其是良恶性腹水鉴别方面提供诊断思路和参考信息。方法：通过回顾性分析,收集在2010年1月-2014年9月期间以“腹水待查”在大连医科大学附属第一医院消化内科住院患者的临床资料,研究病人的性别比例、年龄比例、病因分布及症状体征；采用统计学的方法筛选出对良恶性腹水鉴别有意义的指标,并全面和准确的评价各项指标在腹水病因诊断的中的价值。结果：155例患者纳入研究。腹水的病因排在前三位的依次是：肝硬化腹水(39%),恶性腹水(35%),结核性腹水(14%)。结核性腹水发病平均年龄较低；恶性腹水中以消化道肿瘤最多见(37%)；结核性腹水ADA明显升高,与非结核性腹水比较有显著差别,对结核性腹水诊断的最佳界值为33.5U/L,超过此最佳界值提示结核性腹水；恶性腹水中LDH、总蛋白、AFP、CEA、CA19-9较良性腹水明显增高,有统计学意义；腹水LDH对恶性腹水诊断的最佳界值为78.5U/L,腹水总蛋白对恶性腹水诊断的最佳界值为23.15g/L,腹水AFP对恶性腹水诊断的最佳界值为9.62IU/ml,腹水CEA对恶性腹水诊断的最佳界值5.28ug/L,腹水CA19-9对恶性腹水诊断的最佳界值为12.75U/ml,超过上述最佳界值提示为恶性腹水。腹水CA125在良、恶性腹水组比较差异不显著。结论：1、腹水的前三位病因依次是：肝硬化腹水,恶性腹水,结核性腹水,大部分恶性腹水来源于消化系统恶性肿瘤。2、肝硬化腹水患者男性多于女性,恶性腹水患者女性多于男性。3、常见的腹水病因中,结核性腹水患者平均年龄低于肝硬化及恶性腹水患者。4、肝硬化腹水患者症状以腹泻多见,结核性腹水患者症状以发热、腹痛多见,恶性腹水患者症状以体重减轻多见。5、腹水ADA对结核性腹水具有较高的诊断价值。腹水LDH、腹水总蛋白、腹水AFP、腹水CEA、腹水CA19-9对良恶性腹水的鉴别诊断有价值。腹水CA125对良恶性腹水的鉴别诊断无价值。
[Abstract]:Objective: The clinical symptoms of ascites were different, and their clinical symptoms were different. The etiology of ascites is complicated, and related literature reports indicate that malignant tumor is a common cause of ascites, but also some information indicates that the proportion of liver cirrhosis is high, and the etiology of Bud-Chiari syndrome, malignant mesothelioma, and hepatic vein occlusion is a rare cause of ascites. The method of treatment and prognosis of ascites due to different causes is very important to the etiology of ascites, and how to select an accurate diagnosis method is an urgent problem to be solved by clinical workers. The clinical work is often used to determine the cause of ascites: ascites routine, biochemistry, tumor marker, exfoliative cytology, endoscope, imaging, laparoscope and other means. The diagnosis of malignant ascites has decisive significance for cytology detection of ascites, although its specificity can reach 100%, due to the experience, the number of tumor cell drops, the damage degree of tumor cells, the complex cellular components, the number of cytology tests of ascites exfoliative cytology, The positive rate of non-typical exfoliative cytology was lower. In order to find the index with high sensitivity and specificity, this study provides diagnostic thought and reference information for the diagnosis of ascites due to ascites due to clinical characteristics, ascites biochemistry and tumor marker index. Methods: By retrospective analysis, collected from January 2010 to September 2014 "Ascites to be examined" The clinical data of inpatients with internal medicine were digested in the First Affiliated Hospital of Dalian Medical University, and the sex ratio, age proportion, cause distribution and symptoms of patients were studied. and the value of various indexes in the diagnosis of ascites etiology is comprehensively and accurately evaluated. Results: 155 patients were included in the study. The causes of ascites were cirrhosis ascites (39%), malignant ascites (35%) and tuberculous ascites (14%). The average age of tuberculous ascites was lower, and most of malignant ascites (37%) were digestive tract tumor. The ADA of tuberculous ascites was significantly higher than that of non-tuberculous ascites. The best boundary value for diagnosis of tuberculous ascites was 33. 5U/ L, and the best boundary value suggested tuberculous ascites. The best boundary value of LDH, total protein, AFP, CEA, CA19-9 in malignant ascites was significantly higher than that of benign ascites. The best boundary value of ascites CEA in diagnosis of malignant ascites was 5. 28ug/ L, and the best boundary value of ascites CA19-9 for diagnosis of malignant ascites was 12.75U/ ml. There was no significant difference in ascites fluid in benign and malignant ascites. Conclusion: 1. The first three causes of ascites are cirrhosis ascites, malignant ascites, tuberculous ascites, most malignant ascites is derived from malignant tumor of digestive system. Among the common causes of ascites, the average age of tuberculous ascites was lower than that of patients with cirrhosis and malignant ascites. 4. The symptoms of ascites of liver cirrhosis were seen as diarrhea, and the symptoms of tuberculous ascites were fever and abdominal pain. Ascites ADA has high diagnostic value for tuberculous ascites. Ascites LDH, ascites total protein, ascites AFP, ascites CEA, ascites CA19-9 were valuable for differential diagnosis of benign and malignant ascites. Differential diagnosis of ascites due to ascites has no value in differential diagnosis of benign and malignant ascites.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R442.5

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