Analysis Of Multiple Related Factors In Serum CA125 Elevation In Cirrhosis

Background and ObjectivesCirrhosis is a diffuse liver damage caused by long-term or repeated effects of one or more causes.The common pathogeny of cirrhosis is viral hepatitis in China.When entered the stage of decompensation,it is prone to occur liver complications such as esophagealgastrivarices bleeding,portal vein thrombosis or sponge-like changes,spontaneous bacterial peritonitis,electrolyte and acid-base balance disorders,hepatopulmonary syndrome,renal syndrome,hepatic encephalopathy and so on.The patients with liver complications have a high mortality rate.Once entered the decompensation period,the one year survival rate is reduced to 50%.CA125 was detected by Bast from ovarian epithelial cell carcinoma antigen.Serum CA125 has been used as a tumor marker for diagnosis,treatment of ovarian cancer and efficacy monitoring for more than 20 years.The source of CA125 is extensive.In addition to being widely present in ovarian epithelial cells,it is also present in mesothelial cells and serosal epithelium such as pleura,peritoneum,pericardium,bronchial mucosa,and so on.It has been found that cirrhosis shows elevated serum CA125 levels,especially in patients with decompensated period with ascites.but the exact cause is still unclear.This study aims to explore the factors affecting serum CA125 levels from a variety of perspectives,to understand the cause of elevated serum CA125 in patients with cirrhosis,and to broaden the application value of serum CA125 in patients with liver disease.Materials and MethodsThis study was a retrospective study.208 patients with liver cirrhosis admitted to the second affiliated hospital of zhengzhou university from January 2012 to February 2018 were recruited.After grouped them,the relationship between different age,different gender,different pathogeny of the disease and serum CA125 levels were compared.The relationship between different ascites,different Child-Pugh grades,different ALBI grades and serum CA125 levels were compared.The correlation between them were analyzed.Serum Serum CA125 levels between normal liver function markers group and abnormal liver function markers groups were compared.The correlation between serum CA125 levels and liver function markers were analyzed.Serum CA125 levels between patients with cirrhosis complicated with spontaneous bacterial peritonitis and cirrhosis without spontaneous bacterial peritonitis were compared.The correlation between PMN and serum CA125 were analyzed.The factors that may affect the outcome when the measurement data was related to each other.Then they were analyzed by partial correlation.The meaningful indicators were subjected to multiple linear regression.The ROC curve was used to judge the value of CA125 in the qualitative diagnosis and quantitative diagnosis of ascites.Statistical analysis was performed using SPSS 22.0.Results(1)The serum CA125 levels in each ascites group were statistically significant(P<0.05).The serum CA125 level in the no-ascites group was lower than that in the mild ascites group,the moderate ascites group and the severe ascites group.The differences were statistically significant(P<0.05).The serum CA125 level in the mild ascites group was lower than that in the moderate ascites group and the severe ascites group.The differences were statistically significant(P<0.05).There was no significant difference in the serum CA125 level between the moderate ascites group and the severe ascites group.(P>0.05)(2)The levels of serum CA125 in each Child-Pugh grade were statistically significant(P<0.05).Serum CA125 level in Child-Pugh A grade was lower than that in Child-Pugh B grade and Child-Pugh C grade,the differences were statistically significant(P<0.05).Serum CA125 level in Child-Pugh B grade was lower than that in Child-Pugh C grade,the difference was statistically significant(P < 0.05).(3)The serum CA125 levels of each ALBI grade were statistically significant(P<0.05).The level of serum CA125 in ALBI one level was lower than that in ALBI two level and ALBI three level,the differences were statistically significant(P<0.05).The level of serum CA125 in ALBI two level was lower than that in ALBI three level,the difference was statistically significant(P<0.05).(4)The serum CA125 level in the total bilirubin elevated group,the ALT elevated group,the PT extension group,the albumin reduction group and the prothrombin activity reduction group were higher than that of the normal group.(5)The serum CA125 level in patients with spontaneous bacterial peritonitis was higher than that in patients without spontaneous bacterial peritonitis.The difference was statistically significant(P<0.05).(6)pearman single factor correlation analysis showed that the amount of ascites,depth of ascites,Child-Pugh classification,Child-Pugh classification score,ALBI classification,ALBI score,PMN,total bilirubin,prothrombin time were all positively correlated with serum CA125 level.Albumin,prothrombin activity and serum CA125 levels were all negatively correlated with serum CA125 level.After partial correlation analysis and multiple linear regression analysis,it was suggested that ascites was the main factor for the increase of serum CA125 level.(7)Qualitative and quantitative predictive value of serum CA125 for ascites: The sensitivity and specificity of serum CA125 for judging the presence or absence of ascites were 96.1% and 78.6%.The AUC was 0.949;the sensitivity and specificity of serum CA125 for the diagnosis of cirrhosis with mild ascites were 80.6% and 58.1%.The AUC was 0.600.The sensitivity and specificity of serum CA125 for the diagnosis of moderate ascites were 88.5% and 61.5%.The AUC was 0.693.The sensitivity and specificity of CA125 for the diagnosis of severe ascites were 67.2% and 81.2%,The AUC was 0.813.Conclusions(1)Ascites is the main cause of elevated serum CA 125 levels in patients with cirrhosis.(2)Serum CA 125 level can some extent reflect the volume of ascites,liver function reserve ability and the possibility of spontaneous bacterial peritonitis in cirrhosis.The ability of CA125 to qualitatively diagnose ascites is higher than that of quantitative diagnosis.