Cabral J E, Leitão M C, Guerra C, Tomé L, Pinto M L, Costa D, Monteiro G
Acta Med Port. 1989 Jan-Feb;2(1):17-20.
In order to compare its diagnostic value in the differentiation between malignant and hepatic ascites, we analysed the ascitic fluid concentrations of cholesterol (Ct) and triglycerides (Tg) and the serum-ascites albumin gradient (S-A alb grad) in 58 patients--forty one with chronic liver disease (CLD) and 17 with malignancy. In CLD group the mean values +/- SD for Ct (27.1 +/- 20.1 mg/dl), Tg (34.2 +/- 33.8 mg/dl) and S-A alb grad (1.9 +/- 0.6 g/dl) were significantly different from those obtained in malignant ascites (Ct 103.1 +/- 45.1 mg/dl; Tg 62.1 +/- 43.0 mg/dl; S-A alb grad 0.5 +/- 0.4 g/dl) (p less than 0.001 for all parameters). Application of the cutoff concentrations given in the literature revealed the following results: Ct-Sensitivity (Se) 82.4%, Specificity (Sp) 85.4%, Efficiency (E) 84.5%; Tg-Se 29.4%, Sp 95.1%, E 75.9%; S-A alb grad- Se 88.2%, Sp 97.6%, E 94.8%. The exclusion of the 4 patients with massive hepatic metastasis from malignant group by ultrasound or computer tomography gave an efficiency of 87.0% for Ct, 88.9% for Tg and 98.1% for S-A alb grad. We conclude that: 1) S-A alb grad is the best analysed parameter in the discrimination between malignant and hepatic ascites, 2) the combination with non-invasive imaging methods increases its diagnostic value.
为比较其在鉴别恶性腹水和肝性腹水中的诊断价值，我们分析了58例患者腹水中胆固醇（Ct）、甘油三酯（Tg）的浓度以及血清-腹水白蛋白梯度（S-A alb grad），其中41例为慢性肝病（CLD）患者，17例为恶性肿瘤患者。CLD组中，Ct（27.1±20.1mg/dl）、Tg（34.2±33.8mg/dl）和S-A alb grad（1.9±0.6g/dl）的平均值±标准差与恶性腹水中的值（Ct 103.1±45.1mg/dl；Tg 62.1±43.0mg/dl；S-A alb grad 0.5±0.4g/dl）有显著差异（所有参数p均小于0.001）。应用文献中给出的临界浓度得出以下结果：Ct-灵敏度（Se）82.4%，特异性（Sp）85.4%，效率（E）84.5%；Tg-Se 29.4%，Sp 95.1%，E 75.9%；S-A alb grad-Se 88.2%，Sp 97.6%，E 94.8%。通过超声或计算机断层扫描从恶性组中排除4例有大量肝转移的患者后，Ct的效率为87.0%，Tg为88.9%，S-A alb grad为98.1%。我们得出结论：1）S-A alb grad是鉴别恶性腹水和肝性腹水的最佳分析参数；2）与非侵入性成像方法联合使用可提高其诊断价值。
