本文選題：腹水 + 良惡性　； 參考：《南昌大學》2017年碩士論文

【摘要】：背景:腹水是常見的消化系統(tǒng)疾病體征。良、惡性腹水的診斷、治療及預后截然不同,進行腹水良惡性的鑒別具有重要的臨床意義。腹水診斷通常需結(jié)合患者臨床表現(xiàn),實驗室、影像學檢查及病理檢查綜合診斷。影像學檢查對微小腫瘤檢出率低,病理檢查為有創(chuàng)檢查。腹水實驗室檢查具有方便、經(jīng)濟、快捷、創(chuàng)傷性小等特點,廣泛應用于良惡性腹水診斷鑒別。然而,腹水實驗室檢查指標眾多,各指標對腹水診斷的敏感性和特異性不一,如何選擇敏感性和特異性均高的指標用于臨床實踐,如何進行聯(lián)合檢測來提高鑒別診斷的準確性,目前尚不十分明確。目的:通過復習有關(guān)腹水實驗室檢查的相關(guān)文獻,找出可以提高良惡性腹水鑒別準確性的指標和方法。方法:以“腹水,良惡性,診斷,實驗室檢查,總白蛋白、乳酸脫氫酶、腺苷脫氨酶、葡萄糖、游離脂肪酸、膽固醇、腫瘤標志物、血管內(nèi)皮生長因子、纖維黏連蛋白、a1-抗胰蛋白酶、端粒酶、胸苷激酶、上皮型鈣黏附蛋白”等關(guān)鍵詞進行檢索,找出關(guān)于腹水良惡性鑒別的文章,對其鑒別診斷進行研究并進行總結(jié)。結(jié)論:腹水常規(guī)檢查對區(qū)分腹水性質(zhì)有重要作用,腹水細胞學檢查是惡性腹水診斷的金標準,但其診斷的敏感性較低;SAAG、腹水乳酸脫氫酶對良惡性腹水診斷有一定價值,但對結(jié)核性腹水與惡性腹水診斷價值有限;腹水游離脂肪酸可用于乳腺癌、前列腺癌等代謝相關(guān)腫瘤腹水鑒別;葡萄糖、膽固醇對良惡性腹水檢查具有重要作用。腹水腫瘤標志物對惡性腹水診斷特異度較高,但診斷缺乏靈敏性;腹水血管內(nèi)皮生長因子、纖維黏連蛋白、端粒酶、上皮型鈣黏附蛋白對良惡性腹水診斷具有高靈敏度及特異性;a1-抗胰蛋白酶、胸苷激酶表達與腹水腫瘤細胞密切相關(guān),但對良惡性腹水診斷的臨床價值研究仍較少,有待進一步研究。多項實驗室檢查聯(lián)合檢測可明顯提高良惡性腹水診斷效率,在SAAG、腹水LDH的基礎上聯(lián)合一個或者多個能區(qū)分惡性腹水和結(jié)核性腹水的指標可提高對良、惡性腹水診斷的準確性;SAAG與腹水膽固醇聯(lián)合檢測可顯著提高肝硬化性腹水和肝癌腹水準確度及特異性;腹水細胞學檢查與腫瘤標志物聯(lián)合則可顯著提高惡性腹水的檢出率;多項腫瘤標志物聯(lián)合檢測可提高良惡性腹水診斷的敏感性及準確度。
[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.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R442.5

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