Salerno F, Restelli B, Incerti P, Annoni G, Capozza L, Badalamenti S, Lampertico P, Mojana E, Moser P, Tommasini M
Institute of Internal Medicine, University of Milan, Italy.
Scand J Gastroenterol. 1990 Mar;25(3):251-6.
One-hundred and thirty-three consecutive ascitic patients hospitalized in our Liver Unit were prospectively investigated, to define the accuracy of ascitic fluid analysis in identifying malignancy. Patients with extrahepatic cancer and peritoneal carcinomatosis were characterized by positive cytology and higher ascitic levels of fibronectin, lactic dehydrogenase, carcinoembryonic antigen, and total protein than both patients with uncomplicated cirrhosis and patients with cirrhosis and liver cancer. Ascitic cytology, fibronectin, and lactic dehydrogenase (LDH) were the most sensitive and specific markers of extrahepatic malignancy. In contrast, none of these markers was useful in identifying patients with primary liver cancer complicating cirrhosis. For them, the only alteration of the ascitic fluid was an elevated alpha-fetoprotein concentration. The sensitivity, specificity, and accuracy of ascitic alpha-fetoprotein for detecting liver cancer were 87%, 95%, and 94%, respectively. Combining cytology with the determinations of fibronectin (or LDH) and alpha-fetoprotein in ascitic fluid satisfactorily differentiated 28 of 32 cases of malignancy-related ascites, with very low incidence of false-positives (4-6%). Therefore, in view of the frequent difficulties in detecting liver cancer as a complication of cirrhosis in patients with ascites, it is advisable to determine all these three markers in the same ascitic sample.
我们肝病科对133例连续住院的腹水患者进行了前瞻性研究，以确定腹水分析在识别恶性肿瘤方面的准确性。肝外癌症和腹膜癌患者的特征是细胞学检查呈阳性，腹水纤连蛋白、乳酸脱氢酶、癌胚抗原和总蛋白水平高于单纯肝硬化患者和肝硬化合并肝癌患者。腹水细胞学检查、纤连蛋白和乳酸脱氢酶（LDH）是肝外恶性肿瘤最敏感和特异的标志物。相比之下，这些标志物均无助于识别肝硬化合并原发性肝癌的患者。对他们来说，腹水的唯一改变是甲胎蛋白浓度升高。腹水甲胎蛋白检测肝癌的敏感性、特异性和准确性分别为87%、95%和94%。将细胞学检查与腹水纤连蛋白（或LDH）及甲胎蛋白检测相结合，能令人满意地鉴别出32例恶性腹水相关病例中的28例，假阳性率极低（4-6%）。因此，鉴于在腹水患者中检测肝硬化合并肝癌常常存在困难，建议在同一腹水样本中检测这三种标志物。
