腹水胆固醇测定在门脉高压性腹水和非门脉高压性腹水鉴别诊断中的价值  

The Value of Ascitic Fluid Cholesterol for Differential Diagnosis between Portal and Non-portal Hypertension Ascites

作　　者：许东[1] 龚嵩 宋宇虎[3] 邢铭友[1] 宋建新[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院感染科,武汉430030 [2]华中科技大学同济医学院附属同济医院第二临床学院,武汉430030 [3]华中科技大学同济医学院附属协和医院消化内科,武汉430022

出　　处：《华中科技大学学报（医学版）》2014年第1期86-89,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省自然科学基金资助项目(No.2013CFB077)

摘　　要：目的探讨腹水胆固醇测定方法在腹水鉴别诊断中的价值。方法收集经临床或病理明确诊断的434例腹水样本(其中门脉高压性腹水160例,非门脉高压性腹水274例,后者包括64例良性腹水和210例恶性腹水),进行胆固醇测定和Rivalta试验。结果非门脉高压性腹水的胆固醇水平(2.38±1.32)mmol/L显著高于门脉高压性腹水(0.54±0.64)mmol/L,在临界值设置为1.185mmol/L时,胆固醇测定的敏感度为97.45%,特异度为96.25%,阳性预测值为97.80%,阴性预测值为95.65%,诊断准确度为97.00%;Rivalta试验的敏感度为80.43%,特异度为85.84%,阳性预测值为94.18%,阴性预测值为60.63%,诊断准确度为81.84%。结论用腹水胆固醇水平来区分门脉高压和非门脉高压性腹水简便而又可靠,并有助于病因诊断。Objective To examine the clinical value of ascitic fluid cholesterol in differential diagnosis of ascites. Methods A total of 434 ascitic samples which was clinically or pathologically confirmed were collected for Rivalta＇s test and detection of ascitic fluid cholesterol. They consisted of 160 portal hypertension ascites and 274 non-portal hypertension ascites（64 benign and 210 malignant ascites）. Results The mean ascitic cholesterol level in non-portal hypertension ascites was significantly higher （2.38±1.32）mmol/L than that in portal hypertension ascites （0.54 ±0.64）mmol/L. With the cut off value set at 1. 185 mmol/L, the sensitivity, specificity, positive and negative predictive value and overall diagnostic accuracy of the ascitic cholester ol level for diagnosing portal hypertension ascites were 97.45 %, 96.25 %, 97.80 %, 95.65 % and 97.00 % and the corresponding values for Rivalta＇ s test were 80.43 %, 85.84 %, 94.18 %, 60.63 % and 81.84%, respectively. Conclusion Ascitic fluid choles- terol estimation is an easy and reliable test for differential diagnosis of ascites, and can help to estimate etiology more accurately.

关 键 词：腹水胆固醇 门脉高压 鉴别诊断 

分 类 号：R446.19[医药卫生—诊断学]