C反应蛋白与血管内皮生长因子联合用于腹水鉴别诊断的新组合

A Novel Combination of C-Reactive Protein and Vascular Endothelial Growth Factor in Differential Diagnosis of Ascites.

作者信息

Abdel-Razik Ahmed, Mousa Nasser, Elalfy Hatem, Sheta Tarek Fouad, Awad Mahmoud, Abdelsalam Mostafa, Elhelaly Rania, Elzehery Rasha, Gouda Nawal S, Eldars Waleed

机构信息

Tropical Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, 35516, Egypt.

Internal Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.

出版信息

J Gastrointest Cancer. 2017 Mar;48(1):50-57. doi: 10.1007/s12029-016-9873-x.

DOI:10.1007/s12029-016-9873-x

PMID:27614744

Abstract

BACKGROUND AND AIMS

Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites.

METHODS

In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay.

RESULTS

Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.08 (3.62-6.58) vs. 1.82 (0.64-3.86) ng/ml; P < 0.001 and 12.7 (8.55-17.05) vs. 5.94 (2.57-10.64) ng/ml; P < 0.001], respectively. Ascitic and serum VEGF were significantly increased in malignant ascites than benign ascites patients [0.68 (0.39-0.96) vs. 0.41 (0.25-0.83) ng/ml; P < 0.001 and 0.74 (0.41-1.08) vs. 0.54 (0.23-0.86) ng/ml; P < 0.001], respectively. At a cutoff value of 7.3 and 0.63 ng/ml, serum CRP and VEGF had specificity (77.3 and 89.5 %) and sensitivity (83.1 and 94.9 %) for detecting malignant ascites [area under the curve (AUC) 0.821, 0.921], respectively. At a cutoff value of 2.5 and 0.57 ng/ml, ascitic CRP and VEGF had specificity (81.6 and 85.5 %) and sensitivity (84.7 and 91.5 %) for detecting malignant ascites (AUC 0.842, 0.894), respectively.

CONCLUSION

Elevated ascitic fluid and serum CRP and VEGF values were related to the malignant ascites.

摘要

背景与目的

病因不明的腹水仍然是一个诊断难题，需要新的非侵入性生物标志物来进行精确诊断。我们旨在评估腹水和血清C反应蛋白（CRP）及血管内皮生长因子（VEGF）作为诊断标志物在鉴别恶性腹水和良性腹水中的作用。

方法

在这项前瞻性研究中，对315例连续性腹水患者进行了研究。采用酶联免疫吸附测定法评估腹水和血清中CRP及VEGF的水平。

结果

患者被分为良性腹水组（第1组）（n = 256）和恶性腹水组（第2组）（n = 59）。恶性腹水组的腹水和血清CRP水平显著高于良性腹水组[5.08（3.62 - 6.58）对1.82（0.64 - 3.86）ng/ml；P < 0.001和12.7（8.55 - 17.05）对5.94（2.57 - 10.64）ng/ml；P < 0.001]。恶性腹水患者的腹水和血清VEGF水平也显著高于良性腹水患者[0.68（0.39 - 0.96）对0.41（0.25 - 0.83）ng/ml；P < 0.001和0.74（0.41 - 1.08）对0.54（0.23 - 0.86）ng/ml；P < 0.001]。血清CRP和VEGF在检测恶性腹水时，截断值分别为7.3和0.63 ng/ml，特异性分别为77.3%和89.5%，敏感性分别为83.1%和94.9%[曲线下面积（AUC）分别为0.821、0.921]。腹水CRP和VEGF在检测恶性腹水时，截断值分别为2.5和0.57 ng/ml，特异性分别为81.6%和85.5%，敏感性分别为84.7%和91.5%（AUC分别为0.842、0.894）。