Henderson J M, Stein S F, Kutner M, Wiles M B, Ansley J D, Rudman D
Ann Surg. 1980 Dec;192(6):738-42. doi: 10.1097/00000658-198012000-00008.
The concentrations of 23 plasma proteins were measured by radial immunodiffusion in the plasma and ascites of 17 patients with cirrhosis and four patients with intraperitoneal malignancies, to learn whether there is a selectivity in the movement of proteins from plasma into ascites, analogous to that of proteinuria. Additionally, since some of the proteins are involved in coagulation, we hoped to clarify the coagulopathy frequently seen following peritoneovenous shunting of ascites. Analysis was by groups: group 1 consisted of nine patients with cirrhosis with an ascites-total protein content less than 2.5 g/dl; group 2 consisted of eight patients with cirrhosis with ascites-total protein content greater than or equal to 2.5 g/dl; and group 3 consisted of four patients with malignant ascites. The ratio of the plasma concentration/ascites concentration ([P]/[A]) for each protein was calculated for each patient. In each group the median [P]/[A] for each protein was plotted against the natural logarithm of its molecular weight (In MW). For 21 of the 23 proteins, [P]/[A] showed a close linear relationship to In MW. Fibrogen and plasminogen showed significant (p < 0.0002) elevation above the regression line relating [P]/[A] to In MW. This indicates depletion of fibrinogen and plasminogen in ascites. The ascites in group 1 showed moderate selectivity, defined as the slope of the regression line (1.59), while groups 2 and 3 were essentialy nonselective (0.35 and 0.50). Fibrin-split products were elevated in all ascites but not in plasma, indicating either fibrinolysis or fibrinogenolysis within the ascites. A normal ratio for prothrombin suggests fibrinogenolysis may be the dominant mechanism. Thus the coagulopathy induced by LeVeen valve insertion may be in part secondary to the infusion of plasmin or a plasminogen activator into the circulation.
通过放射免疫扩散法测定了17例肝硬化患者和4例腹腔恶性肿瘤患者血浆及腹水中23种血浆蛋白的浓度，以了解蛋白质从血浆进入腹水的过程中是否存在类似于蛋白尿的选择性。此外，由于某些蛋白质参与凝血，我们希望阐明腹水经腹腔静脉分流术后常见的凝血病。分析按组进行：第1组由9例肝硬化且腹水总蛋白含量低于2.5g/dl的患者组成；第2组由8例肝硬化且腹水总蛋白含量大于或等于2.5g/dl的患者组成；第3组由4例恶性腹水患者组成。计算每位患者每种蛋白质的血浆浓度/腹水浓度比值（[P]/[A]）。在每组中，将每种蛋白质的中位数[P]/[A]与其分子量的自然对数（lnMW）作图。23种蛋白质中的21种，[P]/[A]与lnMW呈密切的线性关系。纤维蛋白原和纤溶酶原高于将[P]/[A]与lnMW联系起来的回归线，差异有统计学意义（p<0.0002）。这表明腹水中纤维蛋白原和纤溶酶原减少。第1组腹水显示出中度选择性，定义为回归线的斜率（1.59），而第2组和第3组基本无选择性（分别为0.35和0.50）。所有腹水中纤维蛋白降解产物均升高，但血浆中未升高，表明腹水内存在纤维蛋白溶解或纤维蛋白原溶解。凝血酶原比值正常提示纤维蛋白原溶解可能是主要机制。因此，LeVeen瓣膜植入引起的凝血病可能部分继发于纤溶酶或纤溶酶原激活剂注入循环系统。
