Usefulness of ascitic fluid cholesterol as a marker for malignant ascites.
Usefulness of ascitic fluid cholesterol as a marker for malignant ascites.
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发表时间：
2005-03
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通讯作者：
S. Rana;S. V. Babu;R. Kocchar
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作者：
S. Rana;S. V. Babu;R. Kocchar
腹水的鉴别诊断是临床上常见的问题。然而，使用可用的生物化学技术区分腹水的恶性与非恶性原因的能力将使对呈现未知病因的腹水的患者的许多昂贵且耗时的诊断研究变得困难。因此，本研究计划评价腹水胆固醇与腹水/血清总蛋白、pH值、葡萄糖、总白细胞计数和血清/腹水白蛋白梯度在区分“恶性”和非恶性腹水方面的诊断有效性。材料/方法对50例患者（恶性腹水25例，非恶性腹水25例）进行腹水总蛋白、腹水/血清（A/S）总蛋白比值、血清腹水白蛋白梯度（SAAG）、腹水pH值、血清和腹水胆固醇及血糖测定。结果恶性腹水的平均腹水胆固醇水平显著高于非恶性腹水，腹水胆固醇的临界值为70 mg/dl; 25例恶性腹水患者中有22例（88%）可与25例非恶性腹水患者区分开来。腹水胆固醇的特异性（100%）和诊断效率（94%）优于血清腹水白蛋白梯度的特异性（84%）和诊断效率（86%）。结论：腹水总蛋白（70%）、腹水血清蛋白比值（74%）、腹水白细胞计数（54%）和恶性细胞学检查（82%）对恶性腹水的诊断效率远低于腹水胆固醇（94%）或SAAG（86%）。
BACKGROUND The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate the diagnostic efficacy of ascitic fluid cholesterol in comparison to the efficiency of ascitic/serum total protein, pH, glucose, total leukocyte count, and the serum/ascitic albumin gradient in differentiating "malignant" from non-malignant ascites. MATERIALS/METHODS A total of 50 patients (25 with malignant ascites and 25 with non-malignant) were evaluated for total ascitic protein, ascites/serum (A/S) total protein ratio, serum ascites albumin gradient (SAAG), ascitic pH, serum & ascitic cholesterol with glucose. RESULTS The mean ascitic cholesterol level was significantly higher in malignant ascites than in non-malignant ascites, with a cut off level of 70 mg/dl for ascitic fluid cholesterol; 22/25 (88%) patients with malignant ascites could be separated from the 25 patients with non-malignant ascites. The specificity (100%) and diagnostic efficiency (94%) of ascitic fluid cholesterol is better than the 84% specificity and 86% diagnostic efficiency of serum ascitic albumin gradient. CONCLUSIONS Total Ascitic protein (70%), Ascitic serum protein ratio (74%), ascitic leukocyte count (54%), and malignant cytology (82%) yielded much lower diagnostic efficiency than ascitic fluid cholesterol (94%) or SAAG (86%) in the diagnosis of malignant ascites.