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目的探讨肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、血管内皮生长因子(VEGF)及C-反应蛋白(CRP)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)在肝硬化合并自发性腹膜炎(SBP)、恶性肿瘤、肾性腹水中的水平及临床意义。方法收集浙江大学医学院附属第一医院2008—2009年收集的26例SBP、31例恶性肿瘤、12例肾病患者的腹水,采用酶联免疫吸附法(ELISA)检测其中IL-6、TNF-α、VEGF的生物学活性,雅培Ci8200全自动生化、免疫分析仪检测CRP、CEA、LDH等指标,并对结果进行比较分析。结果 SBP腹水TNF-α、IL-6、CRP高于肾性和恶性腹水组,差异有统计学意义(P均<0.05);恶性腹水组VEGF、CEA、LDH高于肾性腹水组和SBP组,差异有统计学意义(P均<0.01);恶性腹水组CRP浓度高于肾性腹水组,差异有统计学意义(P<0.01);联合VEGF、CEA、LDH诊断恶性腹水的敏感性和特异性分别为90.3%和76.3%;联合TNF-α、IL-6、CRP诊断SBP腹水敏感性和特异性分别为96.2%和72.1%。结论腹水中TNF-α、IL-6、CRP的升高有助于SBP的诊断,腹水中VEGF、CEA、LDH的浓度对鉴别良、恶性腹水具有一定临床价值。
Objective To investigate the expressions of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) and C-reactive protein (CRP), carcinoembryonic antigen (CEA) and lactate dehydrogenase LDH) in cirrhotic patients complicated with spontaneous peritonitis (SBP), malignant tumors and renal ascites. Methods The ascites of 26 patients with SBP, 31 patients with malignant tumor and 12 patients with nephropathy were collected from the First Affiliated Hospital of Zhejiang University from 2008 to 2009. The levels of IL-6 and TNF-α were detected by enzyme-linked immunosorbent assay (ELISA) , Biological activity of VEGF, Abbott Ci8200 automatic biochemical, immunoassay analyzer CRP, CEA, LDH and other indicators, and the results were compared. Results The levels of TNF-α, IL-6 and CRP in ascites of ascites were significantly higher than those of renal and malignant ascites (all P <0.05). The levels of VEGF, CEA and LDH in malignant ascites were significantly higher than those in renal ascites and SBP , The difference was statistically significant (P <0.01). The CRP level in malignant ascites group was higher than that in renal ascites group (P <0.01), and the combined sensitivity of VEGF, CEA and LDH in the diagnosis of malignant ascites The sensitivity and specificity of combining TNF-α, IL-6 and CRP in the diagnosis of ascites of SBP were 96.2% and 72.1% respectively. Conclusions The increase of TNF-α, IL-6 and CRP in ascites contributes to the diagnosis of SBP. The concentrations of VEGF, CEA and LDH in ascites have certain clinical value in differentiating benign and malignant ascites.