218例老年非门脉高压性腹水病因及临床分析

Etiology and clinical analysis of 218 patients with non portal hypertension ascites

目的探讨218例老年非门脉高压性腹水的病因构成及诊断方法,以利于更好指导老年非门脉高压性腹水的临床诊断。方法选取2011年1月～2011年12月在海南省人民医院收治的218例老年非门脉高压性腹水患者的临床资料进行回顾性分析。结果 218例患者中,恶性肿瘤147例(67.4%),结核性腹膜炎28例(12.8%),自身免疫性疾病8例(3.7%),卵巢良性病变6例(2.8%),心源性腹水10例(4.6%),腹膜炎性改变7例(3.2%),重症药物性肝炎2例(0.9%),原因不明10例(4.6%)。腹水白细胞计数、Rivalta试验、腹水总蛋白对渗出液的鉴别诊断符合率均低于血清-腹水白蛋白梯度对腹水的诊断准确率。腹水的脱落细胞学检查检出率低,需增加送检次数以便提高其阳性率。CEA检测的敏感性偏低,良恶性腹水组癌胚抗原(CEA)比较,差异无统计学意义(P>0.05)。恶性腹水组血清癌抗原125(CA125)、糖链抗原199(CA199)与良性组相比,差异有统计学意义(P<0.05)。结论老年非门脉高压性腹水的病因主要为恶性肿瘤、腹腔结核、自身免疫性疾病等,详细询问病史、认真查体及综合运用多种检查手段有助于确诊。

Objective To investigate the 218 elderly patients with portal hypertension ascites etiology constitute and diagnostic. Methods In order to facilitate better guidance to the clinical diagnosis of senile portal hypertension ascites. 218 cases of elderly non-portal hypertension in patients with ascites from January 2011 to December 2011 were retrospectively analyzed. Results Of the 218 patients, malignancy in 147 cases （67.4%）, 28 cases （12.8%） of tuberculous peritonitis, autoimmune disease in 8 patients （3.7%）, benign ovarian lesions in 6 patients （2.8%）, cardlogenie aseites 10 cases （4.6%）, peritonitis change in 7 cases （3.2%）, severe drug-induced hepatitis in 2 cases （0.9%）, of unknown cause in 10 cases （4.6%） were found. Ascites white blood cell count, the Rivalta trial, the differential diagnosis of ascites total protein exudate meet the diagnostic accuracy rates were lower than serum-ascites albumin gradient ascites. Ascites cytology detection rate was low, the need to increase censorship in order to increase the number of its positive rate. Low sensitivity of CEA in benign and malignant ascites CEA comparison, the difference was not statistically significant （P 〉 0.05）. The malignant ascites serum CA125, CA199 compared with the benign group, the difference was statistically significant （P 〈 0.05）. Conclusion Elderly patients with portal hypertension ascites main cause of malignant tumors, abdominal tuberculosis, autoimmune diseases, a detailed medical history, earnest examination and comprehensive use of various inspection tools are helpful in diagnosis.