血清-腹水白蛋白梯度在鉴别门脉高压性与非门脉高压性腹水中的临床意义

目的探讨血清-腹水白蛋白梯度（SAAC；）在腹水鉴别中的临床应用价值。方法选择诊断明确的腹水患者55例，门脉高压41例、非门脉高压14例，测定血清和腹水总蛋白、白蛋白、乳酸脱氢酶、并进行对比。结果门脉高压组SAAG为（17．86±4．66）g／L，非门脉高压组SAAG为（11．05±6．74）g／L，两组比较有显著性差异（P〈0．001）。对门脉高压诊断的准确率SAAG为94．55％，腹水总蛋白为61．82％、腹水血清总蛋白比值83．64％，腹水乳酸脱氢酶为67．27％。此外，SAAG大于11g／L的病人食管静脉曲张的发生率高。结论SAAG对鉴别门脉高压性与非门脉高压性腹水具有重要的临床意义。     

血清-腹水白蛋白梯度对腹水病因诊断价值的回顾性研究

目的探讨血清-腹水白蛋白梯度（SAAG）在腹水病因诊断中的价值。方法选择腹水患者61例，按最终诊断结果和发生机制分为肝硬化门脉高压组（A组），其他原因门脉高压组（B组）和非门脉高压组（C组）。同日内测定血清及腹水中白蛋白，SAAG=当日血清白蛋白-腹水白蛋白。诊断标准为：SAAG≥11g／L诊断为门脉高压性，反之为非门脉高压性。结果A组SAAG为18．68±5．98g／L，B组为19．37-4-6．29g／L，C组为7．57±3．46g／L。A、B组分别与C组SAAG比较差异具有显著性（P〈0．01），A与B两组间SAAG比较差异无统计学意义（P〉0．05）。结论SAAG对鉴别门静脉高压性和非门静脉高压性腹水具有重要的临床价值，但不能取代腹水有核细胞计数和细胞学等检查，联合检测能有效提高腹水原因诊断准确率。     

血清腹水白蛋白梯度诊断非门脉高压性腹水价值

目的:探讨血清腹水白蛋白梯度(SAAG)诊断非门脉高压性腹水的价值。方法:选择腹水患者60例,其中肝硬化21例、原发性肝癌10例为门脉高压性腹水组。癌性腹水18例、结核性腹膜炎5例、细菌性腹膜炎4例、胰性腹水1例、肾源性腹水1例为非门脉高压性腹水组。分别测定其血清白蛋白及腹水白蛋白值进行比较。结果:非门脉高压组SAAG为(6.94±2.01)g/L,门脉高压组SAAG为(18.67±7.25)g/L,2组比较差异有显著性(P<0.05)。结论:SAAG对鉴别非门脉高压性腹水有重要意义,在临床工作中有较好的指导作用。     

血清腹水白蛋白梯度的临床应用价值

目的 研究血清腹水白蛋白梯度(SAAG)在腹水性质鉴别中的的临床应用价值.方法 选择诊断明确的腹水患者72例,分为门脉高压组40例、非门脉高压组32例,分别测定其血清与腹水中总蛋白和白蛋白的值并进行比较.结果 门脉高压组患者SAAG为(19.18±5.22)g/L,非门脉高压组患者SAAG为(7.82±3.12)g/L,两组比较差异有显著性意义(P＜0.001).SAAG对门脉高压诊断的敏感度95%(38/40),特异度96.9%(31/32),准确度95.8%(69/72),阳性预测值97.4%(38/39),阴性预测值93.9%(31/33),均明显高于腹水总蛋白诊断渗、漏出液分类方法.结论 血清腹水白蛋白梯度对鉴别门脉高压性腹水和非门脉高压性腹水具有重要的临床价值,值得临床推广应用.     

血清-腹水白蛋白梯度在鉴别门脉高压性与非门脉高压性腹水中的临床意义

目的探讨血清-腹水白蛋白梯度(SAAG)在腹水鉴别中的临床应用价值。方法选择诊断明确的腹水患者55例,门脉高压41例、非门脉高压14例,测定血清和腹水总蛋白、白蛋白、乳酸脱氢酶、并进行对比。结果门脉高压组SAAG为(17.86±4.66)g/L,非门脉高压组SAAG为(11.05±6.74)g/L,两组比较有显著性差异(P<0.001)。对门脉高压诊断的准确率SAAG为94.55%,腹水总蛋白为61.82%、腹水血清总蛋白比值83.64%,腹水乳酸脱氢酶为67.27%。此外,SAAG大于11 g/L的病人食管静脉曲张的发生率高。结论SAAG对鉴别门脉高压性与非门脉高压性腹水具有重要的临床意义。     

血清-腹水白蛋白梯度在腹水鉴别诊断中的应用价值

目的:探讨血清-腹水白蛋白梯度(SAAG)在腹水患者中的诊断价值和有效性以及其最适临界值。方法:选取住院的腹水患者66例,均于同日抽取血液和腹水,采用溴甲酚绿比色法,分别测得血和腹水中的白蛋白含量,计算出SAAG,再根据有无门脉高压,将病人分为门脉高压组和非门脉高压组,比较两组间腹水白蛋白和SAAG的差别,并以SAAG的不同临界值,探讨判断门脉高压性腹水的有效性和最适临界值。结果:门脉高压性腹水的白蛋白(3.52±4.09)g/L、SAAG(21.97±6.76)g/L和非门脉高压性腹水的白蛋白(21.91±8.64)g/L、SAAG(8.40±3.69)g/L间差异均存在非常显著性(P<0.001);以SAAG≥12g/L作为最佳临界值来判断是否为门脉高压性腹水,其诊断符合率、似然比、正确诊断指数均可达最大值。结论:腹水白蛋白含量的多少可作为区别门脉高压性腹水和非门脉高压性腹水的重要参考资料,尤其是SAAG可为临床提供重要的参考依据;以SAAG≥12g/L作为判断门脉高压性腹水的临界值较SAAG≥11g/L更具有效性。     

血清-腹水白蛋白梯度检测鉴别腹水性质的临床意义

目的 探讨血清-腹水白蛋白梯度（SAAG）检测鉴别腹水性质的临床意义.方法 选择潢川县人民医院2006年1月至2012年12月212例腹水患者,其中120例为门静脉高压组,92例为非门静脉高压组,对两组患者血清-腹水白蛋白梯度进行检测.结果 两组患者SAAG、腹水总蛋白、腹水血清总蛋白比值等比较差异均有统计学意义（P＜0.05）.结论 血清-腹水白蛋白梯度在检测中较容易进行操作,实用性及价值性更为广泛,相对于传统渗漏出液指标检测更具有意义.     

血清-腹水白蛋白梯度在腹水病因鉴别诊断中的价值

目的 探讨血清-腹水白蛋白梯度(SAAG)在腹水病因鉴别中的应用价值.方法 回顾性分析以腹水待查入院的124例患者的病史,按出院诊断分为门静脉高压相关疾病组(70例)和非门静脉高压相关疾病组(54例);以同一天测定的血清白蛋白水平和腹水白蛋白水平计算SAAG,比较两组SAAG与诊断的关系.结果 门静脉高压相关疾病组的SAAG[(24±7)g/L]显著高于非门静脉高压相关疾病组[(8±4)g/L](P＜0.01).以SAAG≥11 g/L为界限值,诊断门静脉高压相关性腹水的敏感性为95.7%,特异性为98.1%,准确性为96.8%,阳性预期值为98.5%,阴性预期值为94.6%.结论 SAAG鉴别法的鉴别符合率明显高于传统腹水鉴别法,但不能取代腹水有核细胞计数和细胞学等检查.联合检测能有效提高腹水原因诊断准确率.     

血清-腹水白蛋白梯度、腹水/血清CEA、腹水/血清LDH对腹水性质的鉴别价值

目的 探讨综合应用生化指标鉴别良恶性腹水的价值。方法 收集70例腹水患者的腹水及血清,同步测定血清-腹水白蛋白梯度、腹水／血清CEA、腹水／血清LDH,并将结果进行比较分析。结果 恶性腹水组:血清-腹水白蛋白梯度、腹水／血清CEA比值、腹水／血清LDH比值明显高于良性腹水组,有显著性差异(P<0.05~P<0.01),其诊断恶性腹水的敏感性分别为59.8％,67.6％,69.1％;特异性分别为88.9％,94.6％,87.0％;准确性分别为79.3 ％,80.2％,77.8％;三者联合检测的敏感性、特异性、准确性分别为89.2％,90.8％,91.5％。结论 血清／腹水白蛋白梯度、腹水／血清CEA比值、腹水／血清LDH比值可以作为鉴别良性腹水和恶性腹水可靠又实用的指标,三者联合检测可提高检测的敏感性和准确性。     

血清腹水白蛋白梯度在鉴别门脉高压性和非门脉高压性腹水中的临床价值

目的分析血清腹水白蛋白梯度(SAAG)在鉴别门脉高压性与非门脉高压性腹水中的临床价值。方法选取2012年7月至2014年4月100例腹水患者为研究对象,其中门脉高压性腹水60例为观察组,非门脉高压性腹水40例为对照组,通过全自动生化检测仪测定并比较两组患者血清腹水白蛋白、腹水总蛋白(AFTP)水平。结果观察组SAAG水平为(17.85±4.67)g/L,对照组为(11.04±6.75)g/L,两组比较差异有统计学意义(P0.01);观察组SAAG≥11 g/L者57例,对照组2例,差异有统计学意义(P0.01)。SAAG≥11 g/L对门脉高压性腹水诊断敏感度、特异性均为95.00%,与AFTP25 g/L的55.00%、80.00%比较差异有统计学意义(P0.05)。另外,SAAG≥11 g/L者食管静脉曲张发生率明显高于SAAG11 g/L者(P0.01)。结论血清腹水白蛋白梯度≥11 g/L可作为门脉高压性与非门脉高压性腹水鉴别的重要指标,且对食管静脉曲张有一定的预测价值。     

Finding the cause of ascites. The importance of accurate fluid analysis

Diagnostic paracentesis with ascitic fluid analysis is critical to the accurate diagnosis and management of ascites. Recent advances have improved the evaluation of ascitic fluid, among them the serum-ascites albumin difference for discriminating between ascites caused by liver disease and ascites due to malignancy. The ascitic fluid polymorphonuclear leukocyte concentration is the best index for the rapid presumptive diagnosis of spontaneous bacterial peritonitis. Familiarity on the part of the clinician with ascitic fluid interpretation and with ascitic fluid characteristics in various diseases will increase the chances of controlling ascites early.     

Intraabdominal pressure and resorption of ascites in decompensated liver cirrhosis

We determined the levels of total intraabdominal pressure and the tension resulting from the distention of the abdominal wall in 12 patients with ascites resulting from alcoholic cirrhosis of the liver. The measurements were performed first when ascites was tense, and were repeated later when ascites became non-tense with treatment. Using intraperitoneal injections of 131I-labeled human serum albumin, we measured the ascites volume and the resorption of albumin from the ascitic compartment at the same time as the pressure studies. Reduction in intra-abdominal pressure from 29.5 +/- 4.1 to 21.7 +/- 6.0 cm H2O (p less than 0.001) and in tension from 8.3 +/- 2.7 to 2.9 +/- 1.6 cm H2O (p less than 0.001) did not result in significant changes in resorption of albumin from the peritoneal cavity. Lowering of intra-abdominal pressure was not associated with any change in the volume of the resorbed ascitic fluid or the amount of albumin resorbed. We conclude that the ascites resorption rate in cirrhosis is not linearly related to intra-abdominal pressure and that in tense ascites, the decreased permeability of the parietal peritoneum counteracts the effects of the increased intra-abdominal pressure on albumin resorption. Cirrhotic ascites is associated with a changing permeability of the peritoneal membrane.     

Minimizing ascites. Complication of cirrhosis signals clinical deterioration

Ascites is the most common complication of cirrhosis. Its development is associated with a grave prognosis; 50% of patients die within 2 years of diagnosis. An understanding of the analysis of ascitic fluid is essential for the appropriate management of patients with liver disease and ascites. The management of patients with ascites involves a combination of dietary, medical, and surgical approaches. Furthermore, patients with ascites are at risk for ascitic fluid infections and neurohormonal dysregulation that can lead to hepatorenal syndrome. Early recognition of these complications allows therapeutic interventions that minimize further clinical deterioration in already chronically ill patients.     

Pancreatic ascites: diagnostic importance of ascitic lipase.

10 cases of pancreatic ascites are presented. Ascitic fluid lipase is complementary to the determination of ascitic amylase in the diagnosis of pancreatic ascites and may be a more reliable diagnostic indicator of pancreatic ascites on a random ascitic fluid sample. Conservative management, consisting of abdominal paracentesis with or without diurectics, proved to be the treatment of choice in 3 of our patients who failed to reveal an associated pseudocyst.     

Albumin to ascites: demonstration of a direct pathway bypassing the systemic circulation

The transport of plasma albumin and newly made albumin into ascitic fluid was studied in eight patients with cirrhosis and ascites. The thoracic duct was cannulated in two patients and lymph collected over a period of 2 hr. Simultaneously albumin-(131)I and carbonate-(14)C were injected intravenously. The albumin-(131)I measured the transfer of plasma albumin into ascites and into thoracic duct lymph. The carbonate-(14)C, by labeling newly formed albumin, permitted the estimation of the transfer of newly formed albumin into plasma, ascites, and lymph.If the newly synthesized albumin entering ascites and thoracic duct lymph is delivered initially into the plasma, then the ratios of the albumin-(14)C and -(131)I in ascites and lymph compared with the content of albumin-(14)C and -(131)I in plasma would be identical. However, if some newly formed albumin is delivered directly into ascites or lymph, the ratio for albumin-(14)C would be higher than that for albumin-(131)I in lymph or ascites.The ratios of both labeled albumins found in ascites or lymph are expressed as per cent of the total plasma pool. In the eight patients studied 4.2-11.7% of the albumin-(14)C in plasma was found in ascites in 2 hr whereas only 0.4-2.2% of plasma albumin-(131)I entered in this same period. In the two patients studied during thoracic duct lymph drainage 6.1 and 13.5% of newly made albumin-(14)C appeared in lymph in 2 hr whereas only 2.8 and 3.8% of plasma albumin-(131)I was found in the lymph.In cirrhosis with ascites some newly formed albumin entered ascites and thoracic duct lymph by a direct pathway from the liver bypassing the systemic circulation.     

生化指标检测在腹水鉴别诊断中的评价

目的:评价腹水生化指标在腹水鉴别中的诊断效率,探讨单项及组合指标的临床应用价值。方法:测定64例腹水患者,其中恶性腹水者30例,非恶性腹水者34例,用受试者工作特征曲线(ROC)评价腹水总蛋白(TP)、乳酸脱氢酶(LD)、胆固醇(TC)、白蛋白(ALB)、纤维连接蛋白(FN)、糖(GLU)等,指标敏感度和特异度,分析联合检测的诊断效率。结果:单项检测TP、LD、TC、ALB、FN、GLU的敏感度分别为96.7%、90.0%、90.0%、93.3%、90.0%、73.3%;特异度为85.3%、88.2%、88.2%、82.4%、88.2%、79.4%;ROC曲线下面积为0.93、0.93、0.92、0.89、0.85、0.80。2项联合检测(FN与LD或LD与TC)的敏感度、特异度、阳性似然比、诊断准确度分别为89.3%、90%、9.5、90.6%。而FN、TC、LD与TP组合敏感度和特异度分别为86.7%和93.3%,但阳性似然比却都降为7.7。3项联合检测(FN、LD、TC)敏感度、特异度、阳性似然比、诊断准确度分别为83.3%、85.3%、13.8、91.5%。结论:检测腹水TP、LD、TC、ALB和FN对于鉴别良恶性腹水具一定诊断价值,多项指标联合检测,尤其FN、LD、TC3项指标联合,可明显提高诊断效率。     

Components of the renin‐angiotensin‐aldosterone system in plasma and ascites in hepatic cirrhosis

Background Decompensated liver cirrhosis is characterized by activation of the renin‐angiotensin‐aldosterone system (RAAS). We investigated whether compartmentalization of these components occurs in ascitic fluid. Methods In 26 patients with cirrhosis RAAS components and albumin were quantified in simultaneously obtained plasma and ascitic fluid samples. Renin degradation was determined in vitro in plasma and ascites. Results Plasma angiotensinogen was below normal reference values in all but two patients and correlated inversely with plasma renin (r = –0·73, P < 0·001). Plasma renin activity was elevated in most subjects. The plasma and ascites concentrations of renin, prorenin, angiotensinogen and aldosterone were closely (P < 0·001) correlated. Expressed as a percentage of plasma levels, the angiotensinogen level (18 ± 11%) was slightly lower than the albumin level (23 ± 8%), whereas the aldosterone level (43 ± 18%) was considerably higher (P < 0·0001). For renin and prorenin these percentages were much lower (P < 0·0001), despite the fact that their molecular weight is lower than that of albumin and angiotensinogen. This was not due to a more rapid degradation of renin in ascites fluid, since the in‐vitro degradation rates of renin in plasma and ascitic fluid were identical. Conclusion In hepatic cirrhosis ascites can be regarded as an ultrafiltrate of plasma RAAS components. Since differences in molecular weight or metabolic rate cannot explain the low ascites‐to‐plasma ratio of renin and prorenin, either their transcapillary transport is impaired and/or they selectively bind to (pro)renin binding sites.     

The hyperfibrinolytic state of liver cirrhosis: possible pathogenetic role of ascites

We evaluated coagulation and fibrinolytic parameters in both plasma and ascitic fluid of 39 patients with ascites secondary to liver cirrhosis and in 14 cirrhotic patients without ascites, in order to verify if the peritoneal compartment could be involved in the pathogenesis of the hyperfibrinolytic state of the disease. An activation of fibrinolysis, as suggested by increased levels of FDP, D-dimer and tissue plasminogen activator (t-PA) was demonstrated in both ascitic fluid and to a lesser extent in plasma. A positive correlation was also observed between plasma and ascitic fluid plasminogen, antiplasmin and fibrinogen, while a negative correlation was found between plasma and ascitic fluid plasminogen activator inhibitor-1 (PAI-1). Moreover, plasma PAI-1 was significantly lower in patients with ascites than in those without ascites and among ascitic patients in those who had bleeding into soft tissues when compared to those who did not present haemorrhagic events. Finally, a significant association was also shown between positivity for plasma D-dimer (> 200 ng/ml) and the presence of ascites. Taken together, our data suggest an exchange of some coagulation and fibrinolytic proteins between plasma and ascitic fluid and point out the key role of PAI-1 in regulating plasma fibrinolytic potential and in bleeding complications in cirrhotic patients.     

Complement and immunoglobulin levels in serum and ascitic fluid of patients with spontaneous bacterial peritonitis,malignant ascites,and tuberculous peritonitis

BACKGROUND: We determined complement and immunoglobulin levels in ascitic fluid and serum of 47 patients with spontaneous bacterial peritonitis, malignant ascites, or tuberculous ascites. METHODS: Paracentesis was done to confirm the underlying cause of ascites. Biochemical, hematologic, and microbiologic investigations were also done. RESULTS: The highest serum and ascitic fluid C3 and C4 levels and ascitic fluid IgM, IgA, and IgG levels were found in patients with tuberculosis. Ascitic fluid C3 level was found to be higher in the tuberculous group than in the patients with spontaneous bacterial peritonitis or malignant ascites. Ascitic fluid C4 levels were higher in patients with tuberculosis than in those with spontaneous bacterial peritonitis. CONCLUSION: We believe that further studies of the in vivo kinetics of immunoglobulins and complement in ascitic fluid of various causes are necessary for a better understanding of the host defense mechanisms of these fluids.