[腹水脂质及血清-腹水白蛋白梯度在腹水鉴别诊断中的价值]

[Value of ascitic lipids and sero-ascitic gradient of albumin in the differential diagnosis of ascites].

作者信息

Cabral J E, Leitão M C, Guerra C, Tomé L, Pinto M L, Costa D, Monteiro G

出版信息

Acta Med Port. 1989 Jan-Feb;2(1):17-20.

Abstract

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.

摘要

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。