Paré P, Talbot J, Hoefs J C
Gastroenterology. 1983 Aug;85(2):240-4.
Serum-ascites albumin concentration gradient, a parameter of oncotic pressure gradient reflecting presence or absence of portal hypertension, was compared with the usual parameters of ascitic fluid analysis in the differential diagnosis of ascites. Twenty-nine patients with liver disease and 15 patients with malignant neoplasm were prospectively studied. The group with malignant neoplasm showed higher ascitic fluid total protein level (3.70 +/- 1.28 vs. 1.66 +/- 1.20 g/dl), ascites to serum ratio of total protein level (0.58 +/- 0.14 vs. 0.26 +/- 0.14), ascitic fluid lactic dehydrogenase level (756 +/- 693 vs. 151 +/- 125 U/L), ascites to serum ratio of lactic dehydrogenase level (1.13 +/- 0.79 vs. 0.35 +/- 0.22), and lower serum-ascites albumin gradient (0.72 +/- 0.30 vs. 1.85 +/- 0.45) (p less than 0.001 for all parameters). Results of the serum-ascites albumin gradient overlapped the least between the two groups: all but 1 patient with malignant ascites while only 1 patient with liver disease had a gradient lower than 1.1. We conclude that the serum-ascites albumin gradient offers the best diagnostic discrimination between ascites caused by liver disease and ascites caused by a neoplasm.
血清腹水白蛋白浓度梯度是反映门静脉高压存在与否的胶体渗透压梯度参数，在腹水的鉴别诊断中，将其与常规腹水分析参数进行了比较。对29例肝病患者和15例恶性肿瘤患者进行了前瞻性研究。恶性肿瘤组的腹水总蛋白水平较高（3.70±1.28 vs. 1.66±1.20 g/dl）、腹水与血清总蛋白水平之比（0.58±0.14 vs. 0.26±0.14）、腹水乳酸脱氢酶水平（756±693 vs. 151±125 U/L）、腹水与血清乳酸脱氢酶水平之比（1.13±0.79 vs. 0.35±0.22），而血清腹水白蛋白梯度较低（0.72±0.30 vs. 1.85±0.45）（所有参数p均小于0.001）。两组之间血清腹水白蛋白梯度结果的重叠最少：除1例恶性腹水患者外，所有恶性腹水患者以及仅1例肝病患者的梯度低于1.1。我们得出结论，血清腹水白蛋白梯度在鉴别肝病引起的腹水和肿瘤引起的腹水方面具有最佳的诊断区分能力。
