Routine Exanimations And Tumor Markers For Differential Diagnosis Of Ascites

Objective: There are many diseases can lead to ascites, and therapies are different onthe basis of different etiological factors. Differential diagnosis of ascites is importantto the following therapies, especially for ascites caused by malignant diseases;however it may be difficult for doctors. In order to provide some references for clinic,we analyzed a sample of ascites which contains498patients.Methods: First，the medical records (TMR) were obtained by searching Internationalclassification of Diseases (ICD) in our hospital medical record library (MRL). Thenwe analyzed constituent ratios of gender, age and etiology；we directly choose asciticLDH for the differential diagnosis of ascitic fluid nature, and AFP for the differentialdiagnosis of the primary liver carcinoma, and the ADA for the differential diagnosisof tuberculous ascites；however finally markers used for differential diagnosis ofmalignant ascites were chosen by statistics from all the markers. At last we estimatedvalue of exfoliocytology and chromosome in diagnosing ascites. All the statuseswere conducted test of normality, the non-normality status were analyzed innonparametric test.Results：1. Gender: Males65.5%(contains326); Females34.5%(contains172).2. Age: The average age of hepatic cirrhosis group was57.67±13.70; theaverage age of malignant ascites group was54.82±14.87; the average age oftuberculous ascites group was45.52±19.94; the average age of other ascites groupwas56.38±15.32. The average age of tuberculous ascites group was lower thanothers.3. Etiology: The sample contains144cases of hepatic cirrhosis,29cases oftuberculous diseases,265cases of tumor, and60others. Among all the cases, therewere6cases of bloody ascites and4cases of chylous ascites.4. Differentiation of ascitic fluid nature：The level of LDH in exudate washigher than in transudate. According to ROC curve, the area under the curve was0.854, and the best cut-off point of LDH is76.05U/L at which its sensitivity and specificity were84.9%and82.6%.5. Diagnosis of malignant ascites: CA199, CEA, CA125and LDH in serum hadno value of diagnosis of malignant ascites. However, there were five markers helpfulto diagnose malignant ascites including SF in serum, CEA, RBC, WBC and LDH inascites, and the best cut-off of them were111.95μg/L,2.5μg/L,620×106/L,330×106/L and135.35IU/L. Results higher than the above cut-off points suggestedmalignancy．6. Diagnosis of extra-liver malignant ascites：CEA,CA125and LDH in serumand RBC in ascites had no value of diagnosis of extra-liver malignant ascites.However, there were five markers helpful to diagnose extra-liver malignant ascitesincluding CA199and SF in serum, CEA WBC and LDH in ascites, and the bestcut-off of them were114.25u/L,72.8μg/L,2.5μg/L,295×106/L and135.35IU/L.7. Diagnosis of primary liver carcinoma: We chose AFP in serum to diagnoseprimary liver carcinoma, which was higher in the group of primary liver carcinomathan in other groups. According to ROC curve, the area under the curve was0.922,and the best cut-off of AFP in serum was24.55μg/L，at which its sensitivity andspecificity were82.2%and91%.8. Diagnosis of tuberculous ascites: We chose ADA in ascites to diagnosetuberculous ascites, which was higher in the group of tuberculous ascites than inmalignant ascites groups. According to ROC curve, the area under the curve was0.868and the best cut-off of AFP in serum was25.815U/L，at which its sensitivityand specificity were87.5%and89.2%.9. Exfoliocytology and chromosome: There were29cases of extra-livermalignant ascites that had conducted chromosome detection, and21of them foundmalignant cells; there were21cases that had conducted exfoliocytology, however,only14of them found multiploid. There was only1case of primary group hadconducted both exfoliocytology and chromosome, however, nothing had found.Conclusions：There were more males ascetic patients than females. The average ageof tuberculous ascites group was lower than other groups. CEA, LDH and CA125inserum were worthless in diagnosing either malignant ascites or extra-liver malignantascites. CEA, WBC and LDH in ascites and SF in serum were helpful to diagnosis both malignant ascites and extra-liver malignant ascites，it was more likely to beprimary liver carcinoma when SF in serum was extremely high. CA199in serum hadno value in diagnosing malignant ascites but not extra-liver malignant ascites. RBCin ascites was helpful to diagnose malignant ascites; however it had no value indiagnosing extra-liver malignant ascites. AFP in serum had a great value indiagnosing primary liver carcinoma, however, the cut-off remained uncertain. ADAin ascites also had a great value in diagnosing tuberculous ascites. Exfoliocytologyand chromosome were low in positive rate.