胸腹腔积液76例实验室指标的临床观察

Clinical observation of laboratory index for ascites and pleural effusion in 76 cases.

目的 :通过对76例胸腹腔积液进行积液/血清总蛋白、1/2(积液/血清IgG加积液/血清IgA)、积液C -反应蛋白(CRP)以及积液的胆固醇 (Tch、Fch)、溶菌酶 (LZM)、纤维结合蛋白 (FN)、癌胚抗原 (CEA)、唾液酸 (SA)等9项实验室指标的检测 ,以探讨它们对积液性质鉴别的临床意义。方法 :采用临床生化及免疫学方法分别对血清及胸腹腔积液进行上述9项指标测定。结果 :积液/血清总蛋白、1/2(积液/血清IgG加积液/血清IgA)、积液CRP在判断渗出液与漏出液时都有较高的特异性 ;恶性胸腹腔积液中Tch、Fch、CEA、SA都显著升高 ,而在恶性腹腔积液中FN特异性升高 ,在结核性胸腔积液中LZM特异性升高。结论 :上述9项指标在鉴别积液性质时各有其长处 ,在判断积液性质时将多项指标进行联合检测 ,明显优于单一指标的检测。

Objective:To distinguish between exudate and transudate,benign and malignant diseases,tuberculosis and nontuberculosis by some laboratory examination items for specimen.Methods:The 76 cases with ascites and pleural effusion were examined for C-reactive protein(CRP),total cholesterol(Tch),free cholesterol(Fch),lysozyme(LZM),fibronectin(FN),cancer embryonic antigen(CEA),sialic acid(SA) and the ratio of total protein in serous membrance fluid and serum,half the combined sum of ratio of IgG in serous membrane fluid and serum and ratio of IgA in serous membrane fluid and serum by biochemical and immunological assay.Resuluts:1)Three values based on these tests were able to distinguish exudate versus transudate processes with high specificity.They were:A)the ratio of total protein in serous membrane fluid and serum,B)half the combined sum of ratio of IgG in serous membrane fluid and serum and ratio of IgA in serous membrane fluid and serum,and C) CRP in the effusion.2)The levels of Tch,Fch,CEA and SA were each increased in cases of malignant effusion;however,an increase in FN was the most specific indicator of the malignant ascites.3)Increases in LZM were specific for pleural effusions related to tuberculosis.Conclusion:Combined analysis using multiple laboratory values possesses significant advantages over the use of single parameters in the evaluation of serous membrane fluid. [