Prabhu Mukhyaprana, Gangula Rahul Sai, Stanley Weena
Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, India.
Int J Hepatol. 2019 Jun 2;2019:8546010. doi: 10.1155/2019/8546010. eCollection 2019.
Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis.
To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological differentiation of ascites.
The present study is a prospective, descriptive, hospital-based, cross-sectional study.
The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fluid samples were sent for analysis.
ANOVA, Kruskal-Wallis H test, and ROC curve analysis.
Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis.
With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).
血清腹水白蛋白梯度（SAAG）用于鉴别恶性腹水与其他病因（如结核性腹膜炎）是一个主要问题。需要替代性筛查试验来区分恶性腹水和结核性腹膜炎所致腹水。
研究血清腹水脂质梯度和血清腹水蛋白梯度在腹水病理生理鉴别诊断中的应用价值。
本研究是一项基于医院的前瞻性、描述性横断面研究。
对在马尼帕尔卡斯图尔巴医院普通内科住院的腹水患者进行研究。研究纳入60例不同病因（肝硬化、结核性腹膜炎和恶性腹水）的腹水患者。所有患者均接受了临床、实验室和影像学检查，并按照标准治疗方案进行治疗。所有患者均接受腹腔穿刺，送检腹水样本进行分析。
方差分析、Kruskal-Wallis H检验和ROC曲线分析。
在各梯度中，只有血清腹水蛋白梯度（SAPG）和血清腹水白蛋白梯度（SAAG）在各组间具有总体统计学意义（<0.005），但在恶性腹水和结核性腹膜炎之间未观察到显著差异。同样，所测量的所有腹水参数均具有总体统计学意义（<0.005），但恶性腹水组和结核性腹膜炎组之间未观察到显著差异。然而，恶性腹水和结核性腹膜炎之间腹水和血清高密度脂蛋白胆固醇具有统计学意义（<0.05）。
与SAAG相比，当截断值为4时，SAPG是鉴别肝硬化性与非肝硬化性腹水的最佳筛查试验之一，而在鉴别恶性与非恶性腹水时，它是一个敏感性高但特异性极低的不良参数。此外，本研究表明腹水中高密度脂蛋白胆固醇水平是鉴别恶性腹水和结核性腹膜炎（即低SAAG腹水的鉴别）的具有较高敏感性和特异性的有价值标志物。
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