Wang S S, Lu C W, Chao Y, Lee M Y, Lin H C, Lee S D, Tsai Y T, Chen C C, Lo K J
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
J Hepatol. 1994 Jan;20(1):79-84. doi: 10.1016/s0168-8278(05)80470-2.
To define patients with an ascitic fluid polymorphonuclear cell count > or = 250 cells/mm3 or > or = 500 cells/mm3 but without spontaneous bacterial peritonitis, 166 patients with sterile cirrhotic ascites, 46 patients with spontaneous bacterial peritonitis, 123 patients with hepatocellular carcinoma, 67 patients with peritoneal carcinomatosis or massive liver metastasis and 12 patients with other miscellaneous diseases were studied. The sensitivity, specificity and accuracy of the diagnosis of spontaneous bacterial peritonitis were 100, 86 and 88% with the cut-off value of an ascitic fluid polymorphonuclear cell count > or = 250 cells/mm3; and were 93, 91 and 92% with that value > or = 500 cells/mm3, respectively. With the cut-off value > or = 250 cells/mm3 or > or = 500 cells/mm3, the prevalence was 18% or 14% in hepatocellular carcinoma; and 30% or 19% in peritoneal carcinomatosis or massive liver metastasis. The ascitic fluid lactate concentration was insensitive and nonspecific. Among the patients with an ascitic fluid polymorphonuclear cell count greater than the cut-off values, an ascitic fluid erythrocyte count > or = 10,000 cells/mm3, a ratio of ascitic fluid erythrocyte to total leukocyte count > or = 100, and the ratio of ascitic fluid polymorphonuclear cell to total leukocyte count < or = 75% indicated hepatocellular carcinoma, while serum to ascites albumin gradient < or = 1.1 g/dl and a ratio of ascitic fluid polymorphonuclear cell to total leukocyte count < or = 75% indicated peritoneal carcinomatosis or massive liver metastasis.
为了明确腹水多形核细胞计数≥250个细胞/mm³或≥500个细胞/mm³但无自发性细菌性腹膜炎的患者，我们研究了166例无菌性肝硬化腹水患者、46例自发性细菌性腹膜炎患者、123例肝细胞癌患者、67例腹膜癌或大量肝转移患者以及12例其他杂病患者。以腹水多形核细胞计数≥250个细胞/mm³为临界值时，自发性细菌性腹膜炎诊断的敏感性、特异性和准确性分别为100%、86%和88%；以该值≥500个细胞/mm³时，分别为93%、91%和92%。以临界值≥250个细胞/mm³或≥500个细胞/mm³时，肝细胞癌的患病率分别为18%或14%；腹膜癌或大量肝转移的患病率分别为30%或19%。腹水乳酸浓度不敏感且无特异性。在腹水多形核细胞计数高于临界值的患者中，腹水红细胞计数≥10,000个细胞/mm³、腹水红细胞与白细胞总数之比≥100以及腹水多形核细胞与白细胞总数之比≤75%提示肝细胞癌，而血清腹水白蛋白梯度≤1.1 g/dl以及腹水多形核细胞与白细胞总数之比≤75%提示腹膜癌或大量肝转移。
