腹水实验室检查在良、恶性腹水鉴别诊断中的研究进展

发布时间：2018-06-25 06:32

本文选题：腹水 + 良恶性　；参考：《南昌大学》2017年硕士论文

【摘要】：背景:腹水是常见的消化系统疾病体征。良、恶性腹水的诊断、治疗及预后截然不同,进行腹水良恶性的鉴别具有重要的临床意义。腹水诊断通常需结合患者临床表现,实验室、影像学检查及病理检查综合诊断。影像学检查对微小肿瘤检出率低,病理检查为有创检查。腹水实验室检查具有方便、经济、快捷、创伤性小等特点,广泛应用于良恶性腹水诊断鉴别。然而,腹水实验室检查指标众多,各指标对腹水诊断的敏感性和特异性不一,如何选择敏感性和特异性均高的指标用于临床实践,如何进行联合检测来提高鉴别诊断的准确性,目前尚不十分明确。目的:通过复习有关腹水实验室检查的相关文献,找出可以提高良恶性腹水鉴别准确性的指标和方法。方法:以“腹水,良恶性,诊断,实验室检查,总白蛋白、乳酸脱氢酶、腺苷脱氨酶、葡萄糖、游离脂肪酸、胆固醇、肿瘤标志物、血管内皮生长因子、纤维黏连蛋白、a1-抗胰蛋白酶、端粒酶、胸苷激酶、上皮型钙黏附蛋白”等关键词进行检索,找出关于腹水良恶性鉴别的文章,对其鉴别诊断进行研究并进行总结。结论:腹水常规检查对区分腹水性质有重要作用,腹水细胞学检查是恶性腹水诊断的金标准,但其诊断的敏感性较低;SAAG、腹水乳酸脱氢酶对良恶性腹水诊断有一定价值,但对结核性腹水与恶性腹水诊断价值有限;腹水游离脂肪酸可用于乳腺癌、前列腺癌等代谢相关肿瘤腹水鉴别;葡萄糖、胆固醇对良恶性腹水检查具有重要作用。腹水肿瘤标志物对恶性腹水诊断特异度较高,但诊断缺乏灵敏性;腹水血管内皮生长因子、纤维黏连蛋白、端粒酶、上皮型钙黏附蛋白对良恶性腹水诊断具有高灵敏度及特异性;a1-抗胰蛋白酶、胸苷激酶表达与腹水肿瘤细胞密切相关,但对良恶性腹水诊断的临床价值研究仍较少,有待进一步研究。多项实验室检查联合检测可明显提高良恶性腹水诊断效率,在SAAG、腹水LDH的基础上联合一个或者多个能区分恶性腹水和结核性腹水的指标可提高对良、恶性腹水诊断的准确性;SAAG与腹水胆固醇联合检测可显著提高肝硬化性腹水和肝癌腹水准确度及特异性;腹水细胞学检查与肿瘤标志物联合则可显著提高恶性腹水的检出率;多项肿瘤标志物联合检测可提高良恶性腹水诊断的敏感性及准确度。
[Abstract]:Background: ascites are common signs of digestive system diseases. The diagnosis, treatment and prognosis of benign and malignant ascites are very different. The diagnosis of ascites is usually combined with clinical manifestation, laboratory, imaging and pathological examination. The detection rate of small tumor was low in imaging examination, and the pathological examination was invasive. The laboratory examination of ascites is convenient, economical, fast and less traumatic. It is widely used in the diagnosis and differential diagnosis of benign and malignant ascites. However, there are many laboratory indicators of ascites, the sensitivity and specificity of each index to the diagnosis of ascites are different, how to select the indicators with high sensitivity and specificity for clinical practice, and how to carry out combined detection to improve the accuracy of differential diagnosis. At present, it is not very clear. Objective: to find out the indexes and methods that can improve the accuracy of differentiating benign and malignant ascites by reviewing the relevant literatures about laboratory examination of ascites. Methods: with "ascites, benign and malignant, diagnosis, laboratory examination, total albumin, lactate dehydrogenase, adenosine deaminase, glucose, free fatty acid, cholesterol, tumor markers, vascular endothelial growth factor," Fibronectin A 1- antitrypsin, telomerase, thymidine kinase, epithelial cadherin were searched, and articles on differentiating ascites from benign and malignant ascites were found, and their differential diagnosis was studied and summarized. Conclusion: routine examination of ascites plays an important role in distinguishing the nature of ascites. Ascites cytology is the gold standard for the diagnosis of malignant ascites, but its sensitivity is low. Ascites lactate dehydrogenase is valuable in the diagnosis of benign and malignant ascites. Free fatty acids in ascites can be used to differentiate ascites from breast cancer, prostate cancer and other metabolism-related tumors. Glucose and cholesterol play an important role in the detection of benign and malignant ascites. The diagnostic specificity of ascites tumor markers for malignant ascites is high, but the diagnosis is lack of sensitivity; ascites vascular endothelial growth factor, fibronectin, telomerase, ascitic fluid vascular endothelial growth factor, fibronectin, telomerase, ascitic fluid vascular endothelial growth factor E-cadherin has high sensitivity and specificity in the diagnosis of benign and malignant ascites. The expression of thymidine kinase is closely related to ascites tumor cells, but the clinical value of diagnosis of benign and malignant ascites is still few. Further study is needed. Combined laboratory tests can improve the diagnostic efficiency of benign and malignant ascites. The combination of one or more indexes that can distinguish malignant ascites from tuberculous ascites on the basis of SAAGand LDH can improve the diagnosis of benign ascites. Combined detection of saag and ascites cholesterol can significantly improve the accuracy and specificity of ascites of liver cirrhosis and liver cancer, and the detection rate of malignant ascites can be significantly increased by combining ascites cytology with tumor markers. Combined detection of multiple tumor markers can improve the sensitivity and accuracy of diagnosis of benign and malignant ascites.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R442.5

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