Rana Satya V, Babu Sad G Venkatesh, Kocchar Rakesh
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Med Sci Monit. 2005 Mar;11(3):CR136-42.
The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate the diagnostic efficacy of ascitic fluid cholesterol in comparison to the efficiency of ascitic/serum total protein, pH, glucose, total leukocyte count, and the serum/ascitic albumin gradient in differentiating "malignant" from non-malignant ascites.
MATERIALS/METHODS: A total of 50 patients (25 with malignant ascites and 25 with non-malignant) were evaluated for total ascitic protein, ascites/serum (A/S) total protein ratio, serum ascites albumin gradient (SAAG), ascitic pH, serum & ascitic cholesterol with glucose.
The mean ascitic cholesterol level was significantly higher in malignant ascites than in non-malignant ascites, with a cut off level of 70 mg/dl for ascitic fluid cholesterol; 22/25 (88%) patients with malignant ascites could be separated from the 25 patients with non-malignant ascites. The specificity (100%) and diagnostic efficiency (94%) of ascitic fluid cholesterol is better than the 84% specificity and 86% diagnostic efficiency of serum ascitic albumin gradient.
Total Ascitic protein (70%), Ascitic serum protein ratio (74%), ascitic leukocyte count (54%), and malignant cytology (82%) yielded much lower diagnostic efficiency than ascitic fluid cholesterol (94%) or SAAG (86%) in the diagnosis of malignant ascites.
腹水的鉴别诊断是一个常见的临床问题。然而，利用现有的生化技术区分腹水的恶性与非恶性病因的能力，将避免对病因不明的腹水患者进行许多昂贵且耗时的诊断研究。因此，本研究旨在评估腹水胆固醇的诊断效能，并与腹水/血清总蛋白、pH值、葡萄糖、白细胞总数以及血清/腹水白蛋白梯度在区分恶性腹水与非恶性腹水方面的效能进行比较。
材料/方法：共评估了50例患者（25例恶性腹水患者和25例非恶性腹水患者）的腹水总蛋白、腹水/血清（A/S）总蛋白比值、血清腹水白蛋白梯度（SAAG）、腹水pH值、血清及腹水胆固醇与葡萄糖水平。
恶性腹水中的平均腹水胆固醇水平显著高于非恶性腹水，腹水胆固醇的临界值为70mg/dl；25例恶性腹水患者中的22例（88%）可与25例非恶性腹水患者区分开来。腹水胆固醇的特异性（100%）和诊断效能（94%）优于血清腹水白蛋白梯度的特异性（84%）和诊断效能（86%）。
在恶性腹水的诊断中，腹水总蛋白（70%）、腹水血清蛋白比值（74%）、腹水白细胞计数（54%）和恶性细胞学检查（82%）的诊断效能远低于腹水胆固醇（94%）或SAAG（86%）。
