Value of ascitic fluid lipids in the differentiation between cirrhotic and malignant ascites

A. Abdelbaset, Amal A Jouda, Heba F Pasha, A. Soliman, Mostafa Toam, Mohammad N. Elkhashab
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Abstract

Background: The diagnosis of malignant ascites can be difficult. The overall sensitivity of cytology smears for the detection of malignant ascites is 58%–75%. There is a debate about the role of ascitic fluid lipids and their gradients in the differential diagnosis of ascites. This study aims to evaluate the role of ascitic fluid lipids and their gradients in the differentiation of malignant ascites from cirrhotic ascites. Patients and Methods: Ninety-six patients were enrolled in this study divided into two groups according to the cause of ascites; Group I: included 48 patients with malignant ascites and Group II: included 48 patients with cirrhotic ascites. Results: Ascitic fluid cholesterol, triglycerides, and phospholipids were significantly higher among patients of Group I (77.5 ± 11.5, 82.4 ± 17.04 mg/dl, and 0.92 ± 0.14 mmol/L vs. 27.7 ± 7.5, 56.2 ± 16.2 mg/dl, and 0.33 ± 0.09 mmol/L in succession P < 0.001). The cutoff values of cholesterol, triglycerides, and phospholipids were (41.5, 62.5 mg/dl and 0.45 mmol/L successively); they can predict the presence of malignant ascites with sensitivity of (100, 87, and 100% successively) and with specificity of (97.9, 60.4, and 87.5% successively). Conclusion: Ascitic fluid lipids are valuable markers in the differentiation of malignant ascites from cirrhotic ascites.
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腹水脂在肝硬化与恶性腹水鉴别中的价值
背景:恶性腹水的诊断是困难的。细胞学涂片检测恶性腹水的总体敏感性为58%-75%。关于腹水脂质及其梯度在腹水鉴别诊断中的作用存在争议。本研究旨在探讨腹水脂质及其梯度在鉴别恶性腹水与肝硬化腹水中的作用。患者与方法:96例患者按腹水发生原因分为两组;第一组48例恶性腹水,第二组48例肝硬化腹水。结果:ⅰ组患者腹水胆固醇、甘油三酯、磷脂明显高于对照组(77.5±11.5、82.4±17.04 mg/dl、0.92±0.14 mmol/L,而对照组依次为27.7±7.5、56.2±16.2 mg/dl、0.33±0.09 mmol/L, P < 0.001)。胆固醇、甘油三酯和磷脂的临界值依次为41.5、62.5 mg/dl和0.45 mmol/L;预测恶性腹水的敏感性分别为(100,87,100%),特异性分别为(97.9,60.4,87.5%)。结论:腹水脂是鉴别恶性腹水与肝硬化腹水的重要指标。
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