The Etiology And Diagnosis Analysis Of Non-hepatic Ascites

Objective :To analyze the etiology of non-hepatic ascites,and to explore the value of different diagnostic methods for the diagnosis of non-hepatic ascites.Method :We collected 428 cases of unexplained ascites patients in Ningxia Medical University General Hospital from October 2006 to October 2016,which exclude the reason of liver disease,and analyzed the etiology of non-hepatic ascites based on patient data.To collate and count the data of patients with general information(age,sex,nationality,clinical symptoms,signs,etc),laboratory tests(erythrocyte sedimentation rate,C-reactive protein,tumor markers,ascites routine,ascites biochemical,etc),imaging examination(ultrasound,CT,MRI and endoscopic,etc),special examination(peritoneal biopsy,laparoscopy,etc)results,and to explore their diagnostic value of non-liver source ascites.Results:1.Etiology analysis: There were 190 cases(44.4%)of tuberculous ascites,164 cases(38.3%)of malignant ascites and 74 cases(17.3%)of other causes of ascites.2.The value of different diagnostic methods for the diagnosis of non-hepatic ascites.2.1 Age,Sex,Nationality: The mean age of malignant ascites was 56.38±16.04 years old.The average age of tuberculous ascites was 48.20 ± 19.05 years old.The average age of other causes of ascites was 43.32 ± 21.47 years old.The age of malignant ascites was higher than that of tuberculous ascites(P = 0.001,P <0.05)and other causes of ascites(P = 0.000,P <0.05).The susceptible age of malignant ascites was 40-59 years old and that of tuberculous ascites or other causes of ascites was 20-39 years old.There were both no significant difference in the etiology of different sex and nationality of unexplained ascites(P> 0.05).Ovarian cancer and gastric cancer were the main causes of female malignant ascites.Gastric cancer and peritoneal metastatic cancer of unknown primary tumor were the main causes of malignant ascites in men.2.2 Laboratory examination:The levels of C-reactive protein in serum and adenosine deaminase in ascitic fluid were the highest in tuberculous ascites,the mean values were 38.08 ± 29.66 mg/L,47.94 ± 15.11 U/L respectively.The level of lactate dehydrogenase in ascitic fluid was the highest in malignant ascites,with an average value of 335.19±359.82 U/L.The levels of CEA,CA199,CA153 in serum and ascitic fluid and CA125 in ascitic fluid in malignant ascites were significantly higher than those in the other two groups(P <0.05).2.3 Peritoneal biopsy and laparoscopy: There were 54 cases completed the peritoneal biopsy,and 47 cases were finally confirmed by histopathology,including 31 cases of tuberculous peritonitis,16 cases of malignant tumors,7 cases of etiology still unknown,the diagnosis rate was 87.0%.There were 14 cases completed the laparoscopic,and 12 cases were finally diagnosed by histopathology,including 7 cases of tuberculous peritonitis,5 cases of malignant tumors,2 cases of etiology still unknown,the diagnosis rate was 85.7%.Conclusion:1.In this study,the first cause of non-hepatic ascites was tuberculous ascites,the followed was malignant ascites.Ovarian cancer and gastric cancer were the main causes of female malignant ascites.Gastric cancer and peritoneal metastatic cancer of unknown primary tumor were the main causes of malignant ascites in men.2.The age of onset about malignant ascites was the highest.The susceptible age of malignant ascites was 40-59 years old and that of tuberculous ascites or other causes of ascites was 20-39 years old.3.The levels of C-reactive protein in serum,lactate dehydrogenase and adenosine deaminase in ascitic fluid were valuable for the diagnosis of non-hepatic ascites.4.The levels of CEA,CA199,CA153 in serum and ascitic fluid and CA125 in ascitic fluid could be used to identify benign and malignant of non-hepatic ascites.5.Peritoneal biopsy and laparoscopy had a very important value in the diagnosis of non-hepatic ascites.