The Research Of The Differential Diagnosis Value Of Multiple Ascitic Index And The Relation Between The Index And Syndrome Differentiation Of Tympanites

Background:Ascites is the common pathologic sign in clinical practice. Two of the most common causes are liver cirrhosis and malignant tumors. The treatment and the prognosis of them are different.The cytopathology of ascites is the "gold standard" of differential diagnosis of ascites.But the sensitivity of the cytopathology is low and the negative result can't exclude the diagnosis of malignant ascites.Purpose:In this research,we selected ascitic telomerase,serum-ascites albumin gradient (SAAG), CEA, CA125, CA19-9, CA153, LDH and ADA to investigate their differential diagnosis value of ascites. Meanwhile,we probed into the relation between the above index and syndrome differentiation of Tympanites,and tried to find out some objective evidences for TCM syndrome differentiation.Methods:Seventy-two patients with ascites were enrolled into two groups,31 in liver cirrhosis ascites group and 41 in malignant ascites group. Ascitic telomerase, CEA, CA125, CA19-9, CA153, LDH, ADA, albumin of serum and ascites were measured,and then the data was analysed by statistics.According to the standard of TCM syndrome differentiation of Tympanites,divided all the cases into three groups (29 in blood tympanites group,22 in water tympanites group,and 21 in deficiency syndrome of Tympanites),and analysed the difference of the index among different TCM syndrome.Afterwards, patients of liver cirrhosis ascites were divided into two groups according to TCM standard about blood stasis syndrom (20 patients in blood stasis group and 11 patients in non-blood stasis group), and analysed the difference of the above index and the Child-Pugh grading between the two groups.Results:The levels of telomerase, CEA, CA125, CA19-9, CA153, LDH in malignant ascites were significantly higher than in liver cirrhosis ascites, and inversely the level of SAAG. There was statistical significance(P<0.01).The level of ADA was not significantly different between two groups(P>0.05).The sensitivity and specificity of combined detection of telomerase and SAAG were 95.1% and 80.6%; the sensitivity and specificity of combined detection of telomerase and LDH were 90.2%and 90.3%; the sensitivity and specificity of combined detection of SAAG and LDH were 92.7% and 83.9%.The sensitivity of combined detection was higher than individual test. The level of SAAG in blood tympanites group was higher than water tympanites group (P<0.01);the level of SAAG in blood tympanites group was higher than deficiency syndrome group, inversely the level of telomerase and CA153 (P<0.05);there was no significant difference between water tympanites group and deficiency syndrome group(P>0.05).The levels of SAAG and CA125 in the blood stasis group of the liver cirrhosis ascites patients were significantly higher than in the non-blood stasis group (P<0.05).Conclusions:Telomerase, SAAG, CEA, CA125, CA19-9, CA153 and LDH had differential diagnosis value for liver cirrhosis ascites and malignant ascites, and combined detection could increase the diagnosis sensitivity. SAAG could be used for differentiating the blood tympanites syndrome from other syndromes. Telomerase and CA153 might have some correlation with the syndrome differentiation of Tympanites. The levels of SAAG and CA125 in the blood stasis group of the liver cirrhosis ascites were higher than in the non-blood stasis group,which might be related to the worser liver function.