Wang S S, Lee F Y, Chao Y, Chen C C, Lin H Y, Wu S L, Lee S D
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Proc Natl Sci Counc Repub China B. 1996 Apr;20(2):51-7.
In a two-year period, ascitic fluid concentrations of complement 3c and complement 4 were measured in 110 patients with sterile cirrhotic ascites, 31 patients with spontaneous bacterial peritonitis, 65 patients with hepatocellular carcinoma, 36 patients with peritoneal carcinomatosis and 12 patients with miscellaneous diseases (nephrotic syndrome 4, systemic lupus erythematosus 3, secondary peritonitis 2, cardiac ascites 1, eosinophilic peritonitis 1 and tuberculosis peritonitis 1) to assess the clinical utility of ascitic fluid complements. The ascitic fluid level of complements 3c or C4 was significantly higher in patients with peritoneal carcinomatosis (32.8 +/- 10.2, 13.4 +/- 7.4 mg/dL) than in patients with sterile cirrhotic ascites (9.2 +/- 5.2, 4.5 +/- 3.9 mg/dL, p < 0.001), spontaneous bacterial peritonitis (8.2 +/- 4.1, 3.8 +/- 2.4 mg/dL, p < 0.001) or hepatocellular carcinoma (12.8 +/- 8.3, 5.6 +/- 4.4 mg/dL, p < 0.001). However, it was not significantly different from the miscellaneous disease group. To verify that ascites formation is not related to liver disease origin, diagnostic sensitivity, specificity and accuracy were 83.3%, 92.7% and 90.9%, respectively, by the ascitic fluid level of complement 3c higher than the cut-off value (20 mg/dl); or 60.4%, 89.8% and 84.3%, respectively, by the ascitic fluid level of complement 4 higher than the cut-off value (10 mg/dL). A direct correlation was found between the ascitic fluid protein level and the ascitic fluid complement 3c (r = 0.70) or complement 4 (r = 0.57) level. Based on results in this study, we can conclude that measuring ascitic fluid complements is clinically useful in disapproving the liver disease origin of ascites formation. However, it is of little value in diagnosing spontaneous bacterial peritonitis or hepatocellular carcinoma.
在两年时间里，对110例无菌性肝硬化腹水患者、31例自发性细菌性腹膜炎患者、65例肝细胞癌患者、36例腹膜癌患者以及12例患有其他疾病（肾病综合征4例、系统性红斑狼疮3例、继发性腹膜炎2例、心源性腹水1例、嗜酸性粒细胞性腹膜炎1例和结核性腹膜炎1例）的患者测量了腹水补体3c和补体4的浓度，以评估腹水补体的临床应用价值。腹膜癌患者的腹水补体3c或C4水平（32.8±10.2，13.4±7.4mg/dL）显著高于无菌性肝硬化腹水患者（9.2±5.2，4.5±3.9mg/dL，p<0.001）、自发性细菌性腹膜炎患者（8.2±4.1，3.8±2.4mg/dL，p<0.001）或肝细胞癌患者（12.8±8.3，5.6±4.4mg/dL，p<0.001）。然而，与其他疾病组相比无显著差异。为验证腹水形成与肝脏疾病起源无关，以腹水补体3c水平高于临界值（20mg/dl）时，诊断敏感性、特异性和准确性分别为83.3%、92.7%和90.9%；以腹水补体4水平高于临界值（10mg/dL）时，分别为60.4%、89.8%和84.3%。发现腹水蛋白水平与腹水补体3c水平（r=0.70）或补体4水平（r=0.57）之间存在直接相关性。基于本研究结果，我们可以得出结论，测量腹水补体在排除腹水形成的肝脏疾病起源方面具有临床应用价值。然而，在诊断自发性细菌性腹膜炎或肝细胞癌方面价值不大。
