血清—腹水白蛋白梯度在腹水病因诊断中的意义

Value of serum-ascitic albumin gradient in the diagnosis of ascitic etiologies

目的:探讨血清-腹水白蛋白梯度(SAAG)在腹水病因诊断中的意义。方法:选择以腹水原因待查入院,最后诊断明确的腹水患者89例,其中门脉高压组47例、非门脉高压组42例,分别测定其血清与腹水中总蛋白和白蛋白的量并作比较。结果:门脉高压组患者SAAG为(18.42±5.48)g/L,非门脉高压组患者SAAG为(8.07±3.25)g/L,门脉高压组明显高于非门脉高压组(P<0.001)。SAAG对门脉高压相关性腹水诊断的敏感性为93.6%(44/47),特异性97.6%(41/42),准确性为95.5%(85/89),阳性预测值97.8%(44/45),阴性预测值93.2%(41/44),与腹水总蛋白(AFTP)诊断渗、漏出液传统分类方法相比,二者比较差异有统计学意义(P<0.05)。结论:血清-腹水白蛋白梯度在鉴别门脉高压相关性腹水和非门脉高压相关性腹水中具有重要的临床意义,高SAAG腹水大多与门脉高压有关,而低SAAG腹水患者,应努力寻找恶性肿瘤、结核性腹膜炎和自身免疫性疾病等诊断证据。

Objective： To study the value of serum-ascitic albumin gradient （SAAG） in the diagnosis of ascitic etiologies. Methods： 89 patients with ascites were reviewed retrospectively. The patients were divided into 2 groups： the group associated with portal hypertension （47 patients）and the group without portal hypertension （42 patients）. Tested the total protein in and albumin in serum and ascitesd and analyze these parameters. Results： The mean level and standard deviation in SAAG of the group with portal hypertension and the group without portal hypertension waslS. 42 ± 5.48 g/L, and 8.07 ± 3.25 g/L, respectively （P 〈 0.001 ）. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ascitic diagnosis by SAAG in portal hypertension group were 93.6% （ 44/47 ）, 97.6% （ 41/42 ）, 95.5% （ 85/89 ）, 97.8% （44/45）, 93.2% （41/44） respec- tively. All these indexes were significant higher than the results by diagnosing exudates and transndates with ascites fluid total protein （AFTP） （P 〈 0.05 ）. Conclusion： There is significant clinical value for SAAG in identifying ascites fluid of portal hypertension from non portal hypertension. High SAAG is related to portal hypertension, so the patients with low SAAG need further investigation to find the presence of probable malignant tumor,tuberculous peritonitis and autoimmune disease.