血清腹水白蛋白梯度对腹水鉴别诊断的临床价值

目的比较血清腹水白蛋白梯度与渗出液／漏出液概念对腹水鉴别诊断的准确性。方法选择诊断明确患者的51对血清及腹水标本，分为门脉高压组、非门脉高压组，比较两组问白蛋白梯度的差异；51对资料同时被分为渗出液、漏出液组，评价血清腹水白蛋白梯度≥11g／L诊断为门脉高压组，腹水总蛋白≥25g／L、腹水比重≥1．018诊断为渗出液的各自诊断准确率。结果血清腹水白蛋白梯度的诊断准确率为84．3％，腹水总蛋白诊断准确率为70．6％、腹水比重的诊断准确率为58．8％。结论血清腹水白蛋白梯度对腹水鉴别诊断较腹水总蛋白、腹水比重更有价值，腹水分类应以高白蛋白与低白蛋白梯度取代漏出液和渗出液。

Clinical Value of the Serum-Ascites Albumin Gradient in the Differential Diagnosis of Ascites

Objective To compare the serum-ascities albumin gradient (SAAG) and exudate-transudate concept in the differential diagnosis of ascites. Methods A total of 51 paired sera and ascitic fluid data were retrospectively collected from patients with well-characterized causes of ascites. Specimens were classified into portal-hypertension-related group and portal-hypertension-unrelated group then we compared the diference of serum-ascites albumin gradient in the two groups.The 51 paired data were also classified into traditional exudate and transudate categories for the following assessment. The accuracy of defining a serum-ascites albumin gradient of at least 11 g/L as portal hypertension and an AFTP of at least 25 g/L as exudate was assessed. Unpaired t-tests were used for statistical analysis.Results The serum-ascities albumin gradient had a diagnostic accuracy of 84.3%, superior to that of total ascitic fluid protein (70.6%) and to ascitic fluid specific gravity (58.8%). Conclusion The serum-ascities albumin gradient is far more useful than the AFTP as a marker for the differential diagnosis of ascites. High albumin gradient and low albumin gradient should replace the terms transudate and exudate in the classification of ascites.