Ratkoceri Hasi Gentiana, Osredkar Joško, Jerin Aleš
Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Clinical Biochemistry Clinic, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo.
Medicina (Kaunas). 2025 Sep 1;61(9):1582. doi: 10.3390/medicina61091582.
: Diagnosing the underlying cause of ascites remains complex, especially when cytology results are inconclusive. Measuring biomarkers directly in ascitic fluid may offer better diagnostic insight than serum testing alone. This review evaluated the clinical utility of tumor and inflammatory markers in ascitic fluid. : A systematic search was conducted in PubMed and Scopus for studies published from January 2014 to December 2024, with the final search carried out in May 2025. The included studies were observational, comparative or biomarker validation studies evaluating ascitic fluid markers for diagnosing malignant and inflammatory ascites. The extracted outcomes included diagnostic accuracy metrics such as area under the curve (AUC), sensitivity and specificity. Risk of bias was evaluated using the ROBINS-I tool. Studies were excluded if they were case reports, animal studies, cytology-only analyses, or if they lacked biomarker data in ascitic or peritoneal fluid. : Forty-two studies met the inclusion criteria. CEA showed high diagnostic performance when measured in ascitic fluid. Combining markers or using ascitic-to-serum ratios improved diagnostic reliability. Inflammatory markers in ascitic fluid, such as CRP, IL-6 and VEGF added diagnostic value when cytology was inconclusive. : Evaluating biomarkers in ascitic fluid improved diagnostic accuracy. However, the included studies showed considerable methodological heterogeneity and moderate risk of bias.
诊断腹水的潜在病因仍然很复杂，尤其是当细胞学检查结果不明确时。直接在腹水中检测生物标志物可能比单独进行血清检测提供更好的诊断依据。本综述评估了腹水中肿瘤和炎症标志物的临床应用价值。
在PubMed和Scopus数据库中进行了系统检索，以查找2014年1月至2024年12月发表的研究，并于2025年5月进行了最终检索。纳入的研究为观察性、比较性或生物标志物验证性研究，评估腹水中用于诊断恶性腹水和炎性腹水的标志物。提取的结果包括诊断准确性指标，如曲线下面积（AUC）、敏感性和特异性。使用ROBINS-I工具评估偏倚风险。如果研究为病例报告、动物研究、仅细胞学分析，或腹水中或腹膜液中缺乏生物标志物数据，则将其排除。
42项研究符合纳入标准。在腹水中检测癌胚抗原（CEA）时显示出较高的诊断性能。联合使用标志物或采用腹水与血清比值可提高诊断可靠性。当细胞学检查结果不明确时，腹水中的炎症标志物（如CRP、IL-6和VEGF）增加了诊断价值。
评估腹水中的生物标志物可提高诊断准确性。然而，纳入的研究显示出相当大的方法学异质性和中度偏倚风险。
