Banerjee Mithu, Singh Rajeshwar, Arora M M, Srinivas V, Basannar D, Patrikar Seema
Associate Professor, Dept. of Biochemistry, AFMC, Pune-40.
Classified Specialist, Medicine & Oncology, CH (EC) Kolkata.
Med J Armed Forces India. 2011 Apr;67(2):108-12. doi: 10.1016/S0377-1237(11)60005-1. Epub 2011 Jul 21.
Ascitic fluid aspirate cytology, although reasonably specific is not a good screening tool for malignant ascites due to poor sensitivity. Simple test(s) on ascitic fluid or serum which can help differentiate between benign and malignant causes of ascites will be a boon. Ascitic fluid lactate dehydrogenase, cholesterol, and ferritin are the candidate markers evaluated in this study.
Ascitic fluid cytology was done on 30 patients of malignant ascites. The modalities used for diagnosing malignant ascites were positive peritoneal biopsy or CT scan evidence of hepatic metastases. Ascitic fluid biochemistry was done in all these 30 patients as well as 30 cases of non-malignant ascites. The parameters analysed were cholesterol, lactate dehydrogenase, and ferritin. The biochemical parameters were estimated in serum as well.
Cytology had a sensitivity of 40% for the diagnosis of malignant ascites. Ascitic fluid cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 70%, 74%, and 100%, respectively. Serum cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 57%, and 91%, respectively.
Hence, these biochemical markers in ascitic fluid as well as serum can be good screening tools for the diagnosis of malignant ascites.
腹水抽吸细胞学检查虽然具有一定的特异性，但由于敏感性较差，并非恶性腹水的良好筛查工具。能够有助于区分腹水良性和恶性病因的腹水或血清简单检测将是一大福音。本研究评估了腹水乳酸脱氢酶、胆固醇和铁蛋白作为候选标志物。
对30例恶性腹水患者进行了腹水细胞学检查。用于诊断恶性腹水的方式为阳性腹膜活检或肝脏转移的CT扫描证据。对这30例患者以及30例非恶性腹水患者均进行了腹水生化检查。分析的参数为胆固醇、乳酸脱氢酶和铁蛋白。同时也对血清中的生化参数进行了测定。
细胞学诊断恶性腹水的敏感性为40%。腹水胆固醇、乳酸脱氢酶和铁蛋白的敏感性分别为70%、74%和100%。血清胆固醇、乳酸脱氢酶和铁蛋白的敏感性分别为57%和91%。
因此，腹水以及血清中的这些生化标志物可作为诊断恶性腹水的良好筛查工具。
