血清-腹水白蛋白梯度和腹水 ADA 、CA125在结核性腹膜炎诊治中的临床价值

摘要

[目的]探讨血清-腹水白蛋白梯度（SAAG）和腹水腺苷脱氨酶（ADA）、CA125对结核性腹膜炎的临床诊断价值。[方法]选取132例腹水患者进行回顾性分析，并将其分为4组：单纯性结核性腹膜炎组（A组）75例，肝硬化合并结核性腹膜炎组（B组）14例，肝硬化组（C组）17例，其他原因腹水组（D组）26例。对所有患者同一天的血清白蛋白及腹水白蛋白浓度进行检测，计算出SAAG ；并测定腹水中的 ADA、CA125浓度。[结果]以SAAG＜11 g/L为临界值，诊断结核性腹膜炎的敏感度为96.6％（86/89）、特异性为74.4％（32/43）、准确率为89.4％（118/132），A、B组SAAG浓度显著低于C、D组（P＜0.05），A、B组间比较差异无统计学意义（P＞0.05）；以ADA＞40 U/L为临界值，诊断结核性腹膜炎的敏感性为92.1％（82/89）、特异性为97.7％（42/43）、准确率为93.9％（124/132），A、B组腹水ADA浓度与C、D组比较，差异有统计学意义（P＜0.05），A、B组间比较差异无统计学意义（P＞0.05），A、B组抗结核治疗前后腹水ADA浓度比较差异有统计学意义（P＜0.05）；以CA125＞35 U/ml为临界值，诊断结核性腹膜炎的敏感性为100％（89/89）、特异性为34.9％（15/43）、准确性为78.8％（104/132），各组腹水CA125浓度比较均差异无统计学意义（P＞0.05），A、B组抗结核治疗前后腹水CA125浓度比较差异有统计学意义（P＜0.05）。[结论]腹水ADA诊断结核性腹膜炎的敏感性、特异性、准确性均较高，并可作为判断结核性腹膜炎抗结核治疗疗效的观察指标；SAAG诊断结核性腹膜炎的敏感性较高，但特异性较低；腹水CA125对结核性腹膜炎无诊断价值，但可作为治疗疗效追踪的观察指标。%Objective]To explore the clinic diagnostic value of serum-ascites albumin gradient(SAAG) , adenosine deaminase(ADA) ,and CA125 in tuberculous peritonitis.[Methods]A retrospective analysis of 132 patients with peritonitis was investigated.The patients were divided into 4 groups :seventy-five cases of simple tuberculous peritonitis group(Group A) ,fourteen cases of hepatic cirrhosis complicated with tuber-culous peritonitis group(group B) ,seventeen cases of liver cirrhosis group(group C)and 26 cases of others (D group).Serum albumin and ascitic albumin consistency at the same day in all patients were measured and the SAAGs were calculated ,also the ADA and CA125 consistency in the ascites were measured.[Re-sults]The data showed that SAAG ,ADA in Group A ,B and C ,D were significantly different (P<0.05) ,but not significantly different between Group A and Group B (P>0.05).The asites CA125 in Group A ,Group B and C ,Group D had no significant difference(P>0.05).In Group A and Group B the asites ADA ,CA125 level difference before and 2 weeks after treatment showed statistical significance (P<0.05).[Conclusion] The sensitivity ,specificity and accuracy were high in diagnosis of tuberculous peritonitis with the ADA consistency in the ascites ,and ADA level can be used to judge the observation index of tuberculous perito-nitis after anti tuberculosis therapy.The sensitivity of SAAG in diagnosis of tuberculous peritonitis is high , but the specificity is low.However ,there is no value with ascites CA125 in diagnosis of tuberculous perito-nitis ,but it can be used as a therapeutic effect observed indicator.