腹水sHLA-G检测在良恶性腹水鉴别诊断中的价值评估

发布时间：2018-04-24 01:17

本文选题：腹水sHLA-G + 恶性腹水　；参考：《西安医学院》2017年硕士论文

【摘要】：目的:探讨人可溶性白细胞抗原G(Soluble human leukocyte antigen-G,s HLA-G)在良恶性腹水鉴别诊断中的价值。方法:纳入2016年1月至2016年12月于西安医学院第一附属医院住院的腹水患者94例,根据最终诊断分为恶性腹水组(64例)和良性腹水组(30例)。收集腹水样本及对应患者同一时段的血浆样本,ELISA方法检测腹水和血浆中的s HLA-G含量,采用ROC曲线评估腹水s HLA-G检测在良恶性腹水鉴别诊断中的价值,并与传统肿瘤标志物及腹水细胞病理学检查进行对比分析。结果:1.恶性腹水组的腹水s HLA-G含量显著高于良性腹水组[(20.718±3.215)ug/L vs(12.467±3.678)μg/L],差异具有极显著性(t=7.425,P0.001);血浆s HLA-G含量亦显著高于良性腹水组[(19.530±4.355)μg/L vs(13.326±3.192)μg/L],差异具有极显著性(t=4.546,P0.001);两组内腹水和血浆s HLA-G含量配对比较,差异均无统计学意义(P值均0.05)。肝硬化腹水组与结核性腹水组比较,腹水和血浆s HLA-G含量差异均无统计学意义(P值均0.05)。2.恶性腹水组的腹水CEA、CA19-9含量明显高于良性腹水组(P0.05);而腹水AFP、CA125在两组之间的含量差异无统计学意义(P0.05)。3.ROC曲线分析结果显示:当腹水s HLA-G的界值为19.60μg/L时,其预测诊断恶性腹水的灵敏度为87.5%(95%CI:71.0-96.5%),特异度为100%(95%CI:88.4-100%),ROC曲线下面积为0.957(95%CI:0.872-0.992),与传统肿瘤标志物腹水CEA(68.75%,83.33%,0.810)及腹水CA19-9(65.63%,70%,0.710)比较,差异均具有统计学意义(P值均0.05);灵敏度与腹水细胞病理学比较(50%),差异具有统计学意义(P0.05),特异度均为100%。4.s HLA-G与CEA、CA19-9在恶性腹水中的含量不具相关性(P0.05);且与患者的年龄、性别亦无明显关系,但在不同肿瘤类型的腹水中,s HLA-G含量差异具有统计学意义(P0.05)。5.在32例腹水细胞病理学阴性但活检阳性的恶性腹水中,腹水s HLA-G的阳性检出率为75%,与腹水CEA(31.25%)及CA19-9(6.25%)比较,差异均具有统计学意义(P值均0.01)。结论:1.腹水sHLA-G检测对于良恶性腹水的鉴别具有较好的诊断效能,可能是预测诊断恶性腹水的独立指标。2.腹水s HLA-G检测有助于筛查细胞学检查阴性的恶性腹水,可以作为腹水细胞学辅助检查的一个重要生物学标志物。
[Abstract]:Objective: to investigate the value of human soluble leukocyte antigen (G(Soluble human leukocyte antigen-GG) in differential diagnosis of benign and malignant ascites. Methods: from January 2016 to December 2016, 94 patients with ascites were divided into malignant ascites group (n = 64) and benign ascites group (n = 30). The levels of s HLA-G in ascites and plasma samples were detected by Elisa in the same period of time, and the value of s HLA-G detection in the differential diagnosis of benign and malignant ascites was evaluated by ROC curve. The results were compared with traditional tumor markers and ascites cytopathology. The result is 1: 1. The level of s HLA-G in malignant ascites was significantly higher than that in benign ascites [20. 718 卤3.215)ug/L vs(12.467 卤3. 678 渭 g / L], the difference was significant (P < 0. 001), and the plasma s HLA-G content was significantly higher than that in benign ascites [19. 530 卤4. 355 渭 g / L vs(13.326 卤3. 192 渭 g / L]. The difference was not statistically significant (P = 0.05). Compared with tuberculous ascites, there was no significant difference in the levels of s HLA-G in ascites and plasma between cirrhotic ascites group and tuberculous ascites group. The levels of CA19-9 in ascites in malignant ascites were significantly higher than those in benign ascites, but there was no significant difference between the two groups in the content of ascitic fluid AFPnCA125. 3. The results of ROC curve analysis showed that when the limit of ascitic fluid s HLA-G was 19.60 渭 g / L, there was no significant difference between the two groups. Its sensitivity in predicting and diagnosing malignant ascites is 87.5%, and the specificity is 100%, 95% CI 88.4-100. The area under the ROC curve is 0.957 ~ 95CI: 0.872-0.992, which is compared with the traditional tumor marker CEA 68.75 (83.333.330.10) and ascites CA19-9 (65.63) and ascitic fluid CA19-9 (65.63) and ascitic fluid (CA19-9 / 65.63) and the area under the ROC curve is 0.957 ~ 95CI: 0.872-0.992n, compared with the traditional tumor marker CEA (68.75 83.330.10) and ascites CA19-9 and 65.63%. The difference was statistically significant (P < 0.05), the sensitivity was significantly higher than that of ascites cytopathology, the difference was statistically significant (P 0.05), the specificity was 100. 4. S HLA-G and CEA CA19-9 in malignant ascites, and there was no correlation between the sensitivity and the age of the patients. There was no significant relationship between sex and sex, but there was significant difference in the content of HLA-G in ascites of different tumor types (P 0.05. 5). In 32 cases of malignant ascites with negative ascites cytopathology but positive biopsy, the positive rate of ascitic fluid s HLA-G was 75, which was higher than that of ascites CEA 31.25 and CA19-9 6.25). The difference was statistically significant (P < 0.01). Conclusion 1. The detection of sHLA-G in ascites has good diagnostic efficacy for the differential diagnosis of benign and malignant ascites, and may be an independent index of predicting malignant ascites. The detection of ascitic fluid s HLA-G is helpful for screening malignant ascites with negative cytology and can be used as an important biomarker for ascitic cytology auxiliary examination.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.4

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