Abdel-Razik Ahmed, Eldars Waleed, Elhelaly Rania, Elzehery Rasha
Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
J Gastroenterol Hepatol. 2016 Nov;31(11):1868-1873. doi: 10.1111/jgh.13386.
Insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP) are produced mainly by the liver; the output of these markers in response to inflammatory processes may be affected in patients with hepatic dysfunction. This may explain the differences in IGF-1 and CRP values in patients with non-portal and portal hypertension ascites. We aimed to evaluate serum and ascitic fluid IGF-1 and CRP as diagnostic markers in the differential diagnosis of benign and malignant ascites.
In this prospective study, 398 consecutive patients with ascites were included. Serum and ascitic fluid levels of IGF-1 and CRP were measured using an enzyme-linked immunosorbent assay.
Patients were divided into group 1, due to benign ascites (n = 324), and group 2, due to malignant ascites (n = 74). Serum and ascitic IGF-1 were significantly increased in malignant ascites than benign ascites group [305 ± 65.7 ng/mL vs 95 ± 53.8 ng/mL; P < 0.001 and 288 ± 54.7 ng/mL vs 83.2 ± 36.7 ng/mL; P < 0.001], respectively. Serum and ascitic CRP were significantly higher in malignant ascites than benign ascites patients [12.8 ± 6.3 mg/mL vs 6.1 ± 4.9 mg/mL; P < 0.001 and 5.1 ± 2.2 mg/mL vs 1.6 ± 1.3 mg/mL; P < 0.001], respectively. At a cutoff value of 309.4 ng/mL and 7.8 mg/mL, serum IGF-1 and CRP had (95.1%, 81%) sensitivity and (88.6%, 75.5%) specificity for detecting malignant ascites [area under the curve: 0.932, 0.845], respectively. At a cutoff value of 291.6 ng/mL and 2.6 mg/mL, ascitic IGF-1 and CRP had (94.6%, 84%) sensitivity and (83.2%, 80.3%) specificity for detecting malignant ascites (area under the curve: 0.911, 0.893) correspondingly.
Elevated serum and ascitic fluid IGF-1 and CRP levels were associated with malignant ascites.
胰岛素样生长因子-1（IGF-1）和C反应蛋白（CRP）主要由肝脏产生；肝功能不全患者中，这些标志物对炎症过程的反应输出可能会受到影响。这可能解释了非门脉性和门脉性高血压腹水患者IGF-1和CRP值的差异。我们旨在评估血清和腹水IGF-1及CRP作为良性和恶性腹水鉴别诊断的诊断标志物。
在这项前瞻性研究中，纳入了398例连续性腹水患者。采用酶联免疫吸附测定法测量血清和腹水IGF-1及CRP水平。
患者分为两组，第1组为良性腹水患者（n = 324），第2组为恶性腹水患者（n = 74）。恶性腹水组的血清和腹水IGF-1显著高于良性腹水组[分别为305±65.7 ng/mL对95±53.8 ng/mL；P < 0.001以及288±54.7 ng/mL对83.2±36.7 ng/mL；P < 0.001]。恶性腹水患者的血清和腹水CRP也显著高于良性腹水患者[分别为12.8±6.3 mg/mL对6.1±4.9 mg/mL；P < 0.001以及5.1±2.2 mg/mL对1.6±1.3 mg/mL；P < 0.001]。血清IGF-1和CRP在截断值为309.4 ng/mL和7.8 mg/mL时分别具有（95.1%，81%）的敏感性和（88.6%，75.5%）的特异性用于检测恶性腹水[曲线下面积：0.932，0.845]。腹水IGF-1和CRP在截断值为291.6 ng/mL和2.6 mg/mL时分别具有（94.6%，84%）的敏感性和（83.2%，80.3%）的特异性用于检测恶性腹水（曲线下面积：0.911，0.893）。
血清和腹水IGF-1及CRP水平升高与恶性腹水相关。
