THE SERUM-ASCITES ALBUMIN GRADIENT IS SUPERIOR TO THE EXUDATE-TRANSUDATE CONCEPT IN THE DIFFERENTIAL-DIAGNOSIS OF ASCITES
THE SERUM-ASCITES ALBUMIN GRADIENT IS SUPERIOR TO THE EXUDATE-TRANSUDATE CONCEPT IN THE DIFFERENTIAL-DIAGNOSIS OF ASCITES
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DOI：
10.7326/0003-4819-117-3-215
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发表时间：
1992-08-01
影响因子：
39.2
通讯作者：
MCHUTCHISON, JG
中科院分区：
文献类型：
--
作者：
RUNYON, BA;MONTANO, AA;MCHUTCHISON, JG
目的：比较血清-腹水白蛋白梯度与渗出液-漏出液概念在腹水分类中的作用。设计：前瞻性收集具有明确特征的腹水病因患者的腹水数据。一家大型城市医院的肝病科住院和门诊病房及咨询服务。患者：从患有各种形式腹水的连续患者中共收集了901对血清和腹水样本。干预措施：无。主要结果测量：血清-腹水白蛋白梯度和旧渗出液-漏出液概念的实用性（定义为腹水总蛋白浓度[AFTP]）的能力进行比较，以区分腹水形成的原因。96.7%的时候，白蛋白梯度能正确区分门脉高压引起的腹水和非门脉高压引起的腹水。AFTP，当按照旧的渗出液-漏出液概念使用时，仅55.6%的时间正确分类腹水的原因。这导致部分原因是大多数自发感染的样本（传统上预计是渗出液）的AFTP是低的，大多数心脏腹水样本（传统上预计是漏出液）的AFTP是high.Conclusions：渗出液，漏出液的概念应被丢弃在腹水的分类。血清-腹水白蛋白梯度作为门脉高压的标志物远比AFTP有用，但后者仍然是鉴别腹水的有用辅助手段。
Objective: To compare the serum-ascites albumin gradient to the exudate-transudate concept in the classification of ascites.Design: Prospective collection of ascitic fluid data from patients with well-characterized causes of ascites.Setting. Hepatology inpatient and outpatient ward and consult service of a large, urban hospital.Patients: A total of 901 paired serum and ascitic fluid samples were collected from consecutive patients with all forms of ascites.Interventions: None.Main Outcome Measures: The utility of the serum-ascites albumin gradient and the old exudate-transudate concept (as defined by ascitic fluid total protein concentration [AFTP]) were compared for their ability in discriminating the cause for ascites formation.Results: The albumin gradient correctly differentiated causes of ascites due to portal hypertension from those that were not due to portal hypertension 96.7% of the time. The AFTP, when used as defined in the old exudate-transudate concept, classified the causes of ascites correctly only 55.6% of the time. This resulted in part because the AFTP of most spontaneously infected samples (traditionally expected to be exudates) was low, and the AFTP of most cardiac ascites samples (traditionally expected to be transudates) was high.Conclusions: The exudate-transudate concept should be discarded in the classification of ascites. The serum-ascites albumin gradient is far more useful than the AFTP as a marker for portal hypertension, but the latter remains a useful adjunct in the differential diagnosis of ascites.