血清-腹水白蛋白梯度和腹水腺苷脱氨酶对结核性腹膜炎的诊断价值

目的:探讨血清-腹水白蛋白梯度(serum-ascites albumin gradient,SAAG)和腹水腺苷脱氨酶(adenosine deaminase,ADA)对结核性腹膜炎的诊断价值。方法:选取458例腹水患者进行回顾性分析,并将其分为4组:单纯渗出性结核性腹膜炎组(Ⅰa组)39例,肝硬化合并结核性腹膜炎组(Ⅰb组)14例,肝硬化组(Ⅱa组)315例和其他原因组(Ⅱb组)90例。以所有患者血清白蛋白及腹水中的总蛋白浓度进行检测,计算出SAAG;并测定腹水中的ADA浓度。结果:Ⅰa组、Ⅰb组、Ⅱa组、Ⅱb组患者SAAG分别为6.97±1.81、8.24±2.15、20.32±5.24和17.40±4.83g/L;腹水ADA分别为55.06±12.34、49.21±9.96、10.24±3.65和16.88±5.72U/L。结果显示,SAAG和腹水ADA在Ⅰa组与Ⅱa组间,以及Ⅰb与Ⅱa组间比较差异均有显著性意义(P<0.01);而Ⅰa组与Ⅰb组间比较差异无显著性意义(P>0.05)。以SAAG<11g/L为临界值诊断结核性腹膜炎的敏感性为90.6%,特异性为95.6%,准确率为92.4%。以ADA>40U/L为临界值诊断结核性腹膜炎的敏感性为94.3%,特异性为95.6%,准确率为95.4%。结论:SAAG<11g/L,或腹水ADA>40U/L,尤其是后者,可作为诊断结核性腹膜炎的敏感指标。     

血清-腹水白蛋白梯度在腹水病因鉴别诊断中的价值

背景:血清-腹水白蛋白梯度(SAAG)是间接反映门静脉压力的指标。目的:探讨SAAG和其他实验室指标在腹水病因鉴别诊断中的价值。方法:回顾性分析以腹水待查入院的122例患者的病史,按出院诊断分为门静脉高压相关疾病组(68例)和非门静脉高压相关疾病组(54例);以同一天测定的血清白蛋白浓度和腹水白蛋白浓度计算SAAG,比较两组SAAG与诊断的关系。结果:门静脉高压相关疾病组的SAAG(18.5g/L±5.3g/L)显著高于非门静脉高压相关疾病组(7.0g/L±3.1g/L)(P<0.001)。以SAAG≥11g/L为界限值,诊断门静脉高压相关性腹水的敏感性为95.6%,特异性为98.1%,准确性为96.7%,阳性预期值98.5%,阴性预期值94.6%。结论:SAAG虽不能直接对腹水的病因做出诊断,但却能为进一步检查腹水病因提出方向。高SAAG腹水大都与门静脉高压有关,而低SAAG腹水患者,在排除结核性腹膜炎和自身免疫性疾病后,应尽力排查恶性肿瘤。     

CA125与腺苷脱氨酶在结核性腹膜炎患者中的临床意义

临床发现结核性腹膜炎患者血清及腹水CA125、腺苷脱氨酶（ADA）往往升高，尤以腹水明显。本研究通过对诊断明确的结核性腹膜炎患者进行前瞻性研究，探讨检测CA125、ADA在结核性腹膜炎患者中的临床意义。     

γ-干扰素、腺苷脱氨酶、CA125在结核性腹膜炎诊治中的临床价值

目的探讨腹水γ-干扰素、腺苷脱氨酶(ADA)和血清CA125在结核性腹膜炎诊治中的临床价值。方法检测32例结核腹膜炎患者、20例癌性腹水患者的腹水γ-干扰素、ADA和血清CA125水平。结果结核性腹膜炎组中γ-干扰素、ADA的水平及阳性率均高于癌性腹水组,P值均<0.05,治疗前两者血清CA125之间差异无显著性,但经抗结核治疗后,结核性腹膜炎CA125明显降低,P<0.05。结论γ-干扰素、腺苷脱氨酶的检测对结核性和癌性腹腔积液的鉴别有临床意义,可用于两者的鉴别诊断;血清CA125可作为判断结核性腹膜炎抗结核疗效的观察指标。     

血清腹水白蛋白梯度诊断门脉高压性腹水价值

血清腹水白蛋白梯度(SAAG)是国外用于鉴别腹水的重要方法,国内开展较少。本研究收集我院1年来所有住院腹水患者,对其进行血清SAAG分析,现报告如下。     

血清－腹水白蛋白梯度和腹水腺苷脱氨酶对良恶性腹水鉴别意义的探讨

血清－腹水白蛋白梯度（ＳＡＡＧ）是间接反映门静脉压力的一个指标，曾用于良恶性腹水的鉴别诊断。为探讨其对良恶性腹水的鉴别价值，本文对６４例各种病因的腹水患者作ＳＡＡＧ测定。结果显示，肝硬化组ＳＡＡＧ为２５．４４±７．２２ｇ／Ｌ，而腹腔癌组为５．５４±３．１２ｇ／Ｌ两组差异有显著意义（Ｐ＜０．００１）。ＳＡＡＧ鉴别肝硬化与腹腔癌的准确性达９７．９％，但由于肝癌组ＳＡＡＧ亦增大，与肝硬化组相近（Ｐ＞０．０５），而结核性腹水和心源性腹水ＳＡＡＧ则小，与腹腔癌组相近，ＳＡＡＧ鉴别良恶性腹水的准确性降为７９．７％。因此，ＳＡＡＧ不适于良恶性腹水的鉴别。结核性腹水腺苷脱氨酶明显升高，有助于结核和癌性腹水的鉴别。     

血清-腹水白蛋白梯度与门脉高压症关系的探讨

目的 探讨血清-腹水白蛋白梯度(SAAG)与门脉压力是否存在相关.方法28例肝硬化腹水行胃镜检查了解有无食管静脉曲张(EV)及其程度,并测定SAAG.SAAG=当日血清白蛋白-腹水白蛋白,以11g/L为界值分为高SAAG及低SAAG.采用Pearson相关分析SAAG与EV之间的关系.结果26例高SAAG中有22例有EV,而2例低SAAG均无EV.SAAG与EV存在相关(r=0.53,P＜0.01;r=0.55,P＜0.01),但高SAAG的水平与EV的程度并不相关(P＞0.05).结论SAAG与门脉压力密切相关.     

联合检测血清-腹水白蛋白梯度和腹水端粒酶对恶性腹水的诊断意义

探讨联合检测血清-腹水白蛋白梯度(SAAG)和腹水端粒酶对恶性腹水的诊断价值.病理学诊断作为金标准,腹水标本分为试验组(18例)和对照组(26例),测SAAG(SAAG＜11g/L定为阳性)及端粒酶活性,分别计算两组的SAAG均值及端粒酶OD均值、阳性例数、阳性率;如果将任意一项阳性作为诊断标准,灵敏度为88.9%,特异度为65.4%;如果将两项均为阳性作为诊断标准,灵敏度降为50%,但特异度为100%;联合检测SAAG和腹水端粒酶能显著地提高恶性腹水检出率.     

血清腹水白蛋白梯度与渗漏出液概念临床价值的比较

腹水在临床上常被分为渗出性及漏出性两大类。但近些年人们发现渗漏出液的标准并不能真正准确的反映腹水的病因[1,2 ] 。 1987年Ｈｏｅｆｓ提出了血清腹水白蛋白梯度(ｓｅｒｕｍ ａｓｃｉｔｅｓａｌｂｕｍｉｎｇｒａｄｉｅｎｔ,ＳＡＡＧ)的概念[1,3 ] 。本研究旨在比较ＳＡＡＧ与渗漏出液概念对腹水病因诊断的准确率及其之间的差异。以更好地认识ＳＡＡＧ的临床应用价值。一、材料和方法1.研究对象 :研究的对象为 1999～ 2 0 0 1年期间于我院消化科住院治疗的腹水患者 ,选择其中诊断明确并各项资料完备的病例共 6 4例。按照其腹水发生的机制…     

Two cases of tuberculous peritonitis with liver cirrhosis complicated by refractory ascites

We present two cases of tuberculous peritonitis with liver cirrhosis complicated by refractory ascites. Case 1 was a 59-year-old female with alcoholic liver cirrhosis. She was admitted to our hospital because of diarrhea, anorexia and inflammatory reactions on a blood test. She had a high fever of 38°C or more and refractory ascites. Tubercle bacilli infection was suspected based on increased levels of serum CA125 and adenosine deaminase (ADA) in ascites. Laparoscopic examination showed white nodules on the peritoneum, and histologic study confirmed tuberculous nodules. The same bacteria were isolated from culture of ascites. Case 2 was a 55-year-old female with hepatitis C virus-infected liver cirrhosis. She was admitted because of high fever and abdominal fullness due to ascites. High levels of serum CA125 and ADA in ascites and ineffectiveness of treatment with antibiotics plus diuretics led us to start anti-tuberculous therapy before definitive diagnosis. Tuberculus bacillus was later isolated from culture of ascites. It is difficult to make early diagnosis of tuberculous peritonitis in cirrhotic patients with ascites due to a lack of specific symptoms. However, determination of serum CA125 and ADA in ascites and the acid-fast bacterial culture of ascites are useful for early diagnosis.     

CA-125; a new marker for diagnosis and follow-up of patients with tuberculous peritonitis

BACKGROUND: Most malignancies with peritoneal infiltration, especially ovarian cancers and chronic liver diseases associated with ascites give rise to high serum CA-125 levels. Tuberculous peritonitis is another cause for high serum CA-125 levels. AIM: To investigate the relation between serum CA-125 level and response to treatment in tuberculous peritonitis patients. PATIENTS: Ten patients with tuberculous peritonitis were enrolled in the study. METHOD: Definite diagnosis of tuberculous peritonitis was made by acid-fast smears, specific culture, and polymerase chain reaction. Serum CA-125 levels were measured before and at the fourth month of treatment. RESULTS: Before antituberculous treatment, serum CA-125 levels of all patients were very high (mean+/-SD: 475. 80+/-106. 19 U/ml) and comparable with those of patients with ovarian cancers. At the end of the fourth month of treatment, serum CA-125 levels in all patients decreased to within normal limits (<35 U/ml)(20.80:+/-5.18 U/ml) in parallel with the clinical improvement. The differences in CA125 levels before and after treatment were statistically significant (p<0.001). CONCLUSIONS: Results of our study suggest that serum CA-125 levels in patients with tuberculous peritonitis are as high as ovarian cancers associated with peritoneal infiltration. By the end of the fourth month of antituberculous therapy, serum CA-125 levels have returned to normal. We, therefore, suggest that serum CA-125 can be used to evaluate the efficacy of therapy in tuberculous peritonitis.     

卵巢癌抗原在结核性腹膜炎中的诊断意义

为探讨CA125在结核性腹膜炎中的诊断意义。方法应用酶微粒法测定结核性腹膜炎患者的血清及腹水中CA125水平。以多功能腹膜检查针取腹膜活检,作病理诊断。结果显示CA125>600 kU/L中,结核性腹膜炎血清、腹水阳性率分别为16％(8/50)、30％(15/50);CA125<600 kU/L中,结核性腹膜炎血清、腹水分别为133.53±56.52 kU/L、432.32±59.45 kU/L。结论提示CA125水平在结核性腹膜炎中明显升高。     

血清及腹水CA125对结核性腹膜炎的诊断价值

目的　探讨糖抗原1 2 5(CA1 2 5)对结核性腹膜炎诊断价值。方法　应用酶微粒子法测定结核性腹膜炎和肝硬化患者的血清、腹水CA1 2 5水平及正常人血清CA1 2 5水平。应用腹膜多功能检查针取腹膜活检。结果　CA1 2 5>60 0kU/L中 ,结核性腹膜炎血清、腹水阳性例数分别为 2 / 2 0、5 / 2 0 ;肝硬化血清、腹水阳性例数分别为 2 /2 0、3 / 2 0。CA1 2 5<60 0kU/L中 ,结核性腹膜炎血清、腹水分别为 (10 3 42± 68 2 8)kU/L、(4 4 4 82± 68 95 )kU/L ;肝硬化血清、腹水分别为 (63 3 8± 3 7 0 0 )kU/L、(2 2 4 60± 79 3 9)kU/L ;正常对照血清为 (2 4 5 1± 8 5 1)kU/L。结论　CA1 2 5可作为结核性腹膜炎诊断参考指标     

Tuberculous peritonitis developing during chemotherapy for pulmonary and intestinal tuberculosis: a case report

This report is of a case of tuberculous peritonitis that developed during antituberculous chemotherapy. A 54-year-old man had been diagnosed as all-drug susceptible pulmonary and intestinal tuberculosis, and treatment with isoniazid, ethambutol and rifampicin had been initiated. About 5 months later, while still undergoing therapy, a large amount of ascites developed. A diagnostic laparoscopy was performed but due to the adhesion between the greater omentum and the parietal peritoneum, intestinal perforation occurred. An emergency operation was performed and the diagnosis of tuberculous peritonitis was confirmed. There are few reports of abdominal tuberculosis developing during antituberculous chemotherapy. In this case a paradoxical response may have been involved in the pathogenesis.     

肝硬化腹水并发结核性腹膜炎的预警指标分析

目的分析肝硬化腹水并发结核性腹膜炎预警指标。方法回顾性分析2010年1月至2012年12月重庆医科大学附属第二医院62例肝硬化腹水患者的临床资料。其中肝硬化腹水并发结构性腹膜炎(TBP)患者27例(TBP组);肝硬化腹水未发生TBP患者35例(非TBP组),收集2组患者的临床情况和实验室检查结果。采用χ2检验和Mann-Whitney U检验进行单因素分析;Logistic回归多因素检验进行多因素分析。结果性别、原发性腹膜炎病史、血沉(ESR)、血清结核抗体、腹水淋巴细胞为主(≥50%)及凝血酶原活动度(PTA)等指标在2组的差异具有统计学意义(P0.05)。原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞为主(≥50%)的肝硬化腹水患者发生结核性腹膜炎的OR分别为1.933、3.205、2.716、11.701;其工作特征曲线(ROC)下面积(AUC)分别是0.831、0.815、0.775、0.935,P值均0.05。结论既往有原发性腹膜炎病史、PTA、ESR、腹水淋巴细胞≥50%是肝硬化腹水患者发生结核性腹膜炎的预警指标;各预警指标的预测价值均较好,尤其腹水淋巴细胞为主(≥50%)预测价值最大。     

血清-腹水清蛋白梯度与肿瘤抗原125水平在肝硬化检测中的意义

[目的]探讨肝硬化血清-腹水清蛋白梯度（SAAG）和肿瘤抗原125（CA125）水平与肝损害和腹水蓄量的关系。[方法]肝硬化腹水患者87例,根据Child-Pugh改良计分法判定肝功能损害程度,A级22例,B级38例、C级27例,检测SAAG及腹水CA125水平,分别计算3组的SAAG及CA125均值,结合SAAG和CA125水平,观察腹水再发生的情况。[结果]SAAG和CA125随Child-Pugh肝功能评分的增加均逐渐增高,各组之间比较差异有统计学意义（P≤0.01）,且随着腹水量的增多,SAAG和CA125水平也呈逐渐升高趋势。SAAG和CA125呈正相关,随肝功能的减退逐渐升高。[结论]SAAG和CA125水平可作为反映肝硬化患者肝损害程度的指标之一,并对衡量肝硬化患者的预后,监测肝硬化患者腹水消长有一定的参考价值。     

Presentation and role of peritoneoscopy in the diagnosis of tuberculous peritonitis

This study represents the clinical and laboratory features of 135 tuberculous peritonitis cases in whom peritoneoscopic investigation was used routinely. Disease was more common in women than men (1.5:1) and was most frequently encountered in the third and fourth decades in life. The most common presenting symptoms were abdominal distension (96%), abdominal pain (82%), weight loss (80%), weakness (76%), loss of appetite (73%) and fever (69%). The most common physical findings were ascites (96%), fever (75%) and abdominal tenderness (43%). One hundred and twenty-nine cases (95.5%) showed exudative type tuberculous peritonitis with variable amounts of ascites and filmy adhesions. In six patients (4.5%) the disease was of the plastic (dry) type. Peritoneoscopic investigations of 139 patients suggested tuberculous peritonitis but four cases showed histologically proven malignancy (3%). Laparoscopic diagnoses of the remaining cases were confirmed by histology (97%). The laparoscopic appearance of scattered yellowish-white nodules, approximately 1-5 mm in size, on the peritoneal surfaces, and filmy adhesions were suggestive of tuberculous peritonitis. A non-fatal colon perforation occurred as a major complication. After antituberculous therapy patients were followed for at least 1 year. Peritoneoscopy with simultaneous biopsy is the ideal and most accurate diagnostic modality in the diagnosis of tuberculous peritonitis.     

腺苷脱氨酶诊断结核性脑膜炎价值Meta分析

目的通过Meta分析确定检测脑脊液(CSF)中腺苷脱氨酶(ADA)的含量是否有助于结核性脑膜炎的早期诊断。方法检索Medline,Embase,BIOSIS和Cochrane等数据库,检索时间为1995年1月至2009年12月,收集关于测定CSF中ADA以诊断结核性脑膜炎的相关英文文献,并用QUADAS标准进行质量评价,采用Metadisc1.4和SPSS13.0软件,用随机效应模型汇总各研究中ADA诊断结核性脑膜炎的敏感度、特异度以及其他指标,绘制汇总受试者工作特征曲线并探讨其诊断特性。结果最终有9项独立研究纳入本次Meta分析,ADA诊断结核性脑膜炎的总体敏感度0.77(95%CI 0.72～0.82);特异度0.91(95%CI 0.90～0.93);阳性似然比7.93(95%CI 5.85～10.76),阴性似然比0.28(95%CI 0.19～0.41),合并受试者工作特征曲线下面积为0.9129,但在结核性脑膜炎与化脓性脑膜炎的鉴别诊断中特异度降为0.75(95%CI 0.67～0.82)。结论 ADA诊断结核性脑膜炎的敏感度、特异度均较高,检测CSF中的ADA有助于结核性脑膜炎的诊断,但在与化脓性脑膜炎相鉴别时诊断效力下降,需参考其他检测指标。