血清腹水白蛋白梯度对腹水分类的鉴别价值

Clinical Value of the Serum-Ascites Albumin Gradient in Ascites Classification

目的探讨血清腹水白蛋白梯度(SAAG)对腹水病因的鉴别价值。方法选取我院住院或门诊的腹水患者66例,按腹水的发生机制分为门静脉高压组(A组)和非门静脉高压组(B组),分别测定SAAG、腹水总蛋白(AFTP)、腹水/血清总蛋白比值(A/S)、腹水乳酸脱氢酶(LDH),并对结果进行统计学处理。结果门静脉高压组SAAG值为19.17±5.36,非门静脉高压组SAAG值为8.24±2.76,两组比较差异有统计学意义(P<0.01)。SAAG指标的敏感性、特异性、阳性预测值、阴性预测值、准确率依次为94.59%、86.21%、89.74%、92.59%和90.91%,而AFTP、LDH、A/S的准确性依次为77.27%、65.15%、65.15%。结论SAAG与门静脉高压存在着相关性;SAAG在鉴别门静脉高压性腹水与非门静脉高压性腹水时优于传统的渗漏出液指标,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。

Objective To evaluate the clinical significance of serum-ascites albumin gradient （SAAG） in ascites classification. Methods 66 patients with the ascites fluid were divided into two groups： portal hypertension group（group A） and non-portal hypertension group（group B）. SAAG, AFTP, A/S and LDH were measured and analyzed. Results There is an obvious difference of SAAG between group A and group B （P〈O.O1）. SAAG of group A was 19.17±5.36, and group B was 8.24±2.76. The sensitivity, specificity, positive prediction, negative prediction, and accuracy of the SAAG were 94.59%, 86.21%, 89.74%, 92.59% and 90.91%, respectively, while the accuracy of the AFTP, LDH and A/S were 77.27%, 65.15% and 65.15%, respectively. Conclusion The level of SAAG is correlated with portal hypertension. SAAG is superior to the exudate-transudate concept in the diagnosis of ascites of portal hypertension, and is useful to identify ascites fluid of portal hypertension and non-portal hypertension.