Chubb Sa Paul, Williams Robin A
Biochemistry Department, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA 6150, Australia.
School of Biomedical Science, University of Western Australia, Crawley, WA 6009, Australia.
Clin Biochem Rev. 2018 May;39(2):39-50.
Biochemical testing of peritoneal and pleural fluids is carried out widely, although the range of tests likely to be useful is limited in comparison to the repertoire of tests available in a modern biochemistry laboratory. Fluids accumulate when pathological processes cause an imbalance between hydrostatic pressure gradients, capillary membrane permeability and lymphatic capacity, resulting in protein-poor transudates or inflammatory exudates. In peritoneal fluid, albumin is the most useful test, for the calculation of the serum-ascites albumin gradient; protein and LDH have a role regarding risk and diagnosis of spontaneous bacterial peritonitis and amylase may be useful in diagnosing fluid accumulation due to pancreatitis. Peritoneal fluid pH and glucose are not indicated analyses. For pleural fluid, protein and LDH are important in distinguishing between transudate and exudate using Light's criteria; albumin and the serum-effusion albumin gradient may have a complementary role in patients already on diuretics. Pleural fluid pH is the most useful marker of infection although LDH and glucose are also used. Pleural fluid amylase is often measured but, if raised, is more likely to reflect a malignant process than pancreatic disease as the former is much more prevalent. Tumour markers in both peritoneal and pleural fluids generally have limited diagnostic accuracy for detecting local malignancy. Limited studies validating standard serum test methods for use with pleural and peritoneal fluids have been published but work is progressing in this area both in Australasia and overseas and opportunities exist for contributing to this effort.
尽管与现代生物化学实验室可进行的检测项目相比，可能有用的检测范围有限，但对腹水和胸水进行生化检测仍被广泛开展。当病理过程导致静水压梯度、毛细血管膜通透性和淋巴引流能力之间失衡时，液体就会积聚，从而产生蛋白含量低的漏出液或炎性渗出液。在腹水中，白蛋白是最有用的检测项目，用于计算血清腹水白蛋白梯度；蛋白质和乳酸脱氢酶在自发性细菌性腹膜炎的风险评估和诊断中具有一定作用，淀粉酶可能有助于诊断胰腺炎导致的液体积聚。腹水的pH值和葡萄糖检测并无必要。对于胸水，蛋白质和乳酸脱氢酶对于使用Light标准区分漏出液和渗出液很重要；白蛋白和血清-胸水白蛋白梯度在已使用利尿剂的患者中可能具有补充作用。胸水pH值是感染最有用的标志物，尽管乳酸脱氢酶和葡萄糖也会被检测。胸水淀粉酶常被检测，但如果升高，更可能反映恶性病变而非胰腺疾病，因为前者更为常见。腹水和胸水中的肿瘤标志物在检测局部恶性肿瘤方面的诊断准确性通常有限。虽然已经发表了一些验证用于胸水和腹水的标准血清检测方法的有限研究，但在澳大利亚和新西兰以及海外，这一领域的工作仍在推进，参与这项工作的机会依然存在。
