| Objective:To analyze the etiology and clinical characteristics of patients with the cause of ascites to be determined,and discusse the value of various diagnostic methods,in order to provide clinical ideas for the diagnosis of the etiology of origin ascites.Method:Collecte 131 patients with unknown origin ascites that excluded liver cirrhosis,were selected from January 2015 to May 2019 in the Department of hepatobiliary and Pancreatic Medicine of the first Hospital of Jilin University,analyze cinical data commonly,complete physical examination and laboratory,imaging and pathological examination,and the application of statistical software to analyze the relevant data,to definite the causes of patients with ascites and discuss the diagnosis value.Result:1.Analysis of etiological composition: Among the 131 cases patients,74 cases(56.4%)were malignant ascites,followed by 39 cases(29.7%)tubercular ascites and 18 cases(13.7%)other causes,including4 cases of hepatic venule occlusion,3 cases of eosinophilic gastroenteritis,2 cases of connective tissue disease(SLE),2 cases of pancreatitis,1 case of exudative enteropathy,1 case of benign ovarian tumor,1 case of portal vein embolism,1 case of malnutrition,1 case of buga’s syndrome,and 2cases of ascites with unknown causes.2.Sex,age and etiology analysis showd that no significant difference between gender and etiological composition of ascites P>0.05.Malignant ascites was the most common cause in both males and females,with 44(58.9%)and 30(53.6%),respectively.The mean age of malignant ascites group was 62.83±11.62 years old,which was higher than that of tuberculous ascites group(P<0.05)and other causes ascites group(P<0.05).3.Laboratory index analysis showd that the median of sedimentation was 31.5mm/h in the malignant ascites group,57mm/h in the tuberculous ascites group,and 10mm/h in the ascites group of other causes.The serum sedimentation level of malignant ascites group and of tuberculous ascites group was higher than that of other etiological ascites group(P<0.05),the difference was statistically significant;The mean of total ascites protein was 42.05±9.32g/L in the malignant ascites group,45.54±8.75g/L in the tuberculous ascites group,31.53±12.76g/L in the other causes ascites group.The total protein of ascites in malignant ascites group and in tuberculous ascites group was higher than that in other causes ascites group(P<0.05),and the difference was statistically significant.The median lactate dehydrogenase was 493U/L in the malignant ascites group,396U/L in the tuberculous ascites group,and165U/L in the ascites group of other causes.The lactate dehydrogenase in the malignant ascites group and in tuberculous ascites group was higher than that in the other causes ascites group(P<0.05),and the difference was statistically significant;median of ascites adenosine deaminase was54.20 U/L in the Tuberculous ascites group,was 10.09 U/L in malignant ascites gruop and was 6.70 U/L in other causes ascites group,ascitesadenosine deaminase levels in tuberculous ascites group was higher than the cancerous ascites group(P < 0.05),and other causes ascites group(P< 0.05),the difference was statistically significant.4.Tumor markers distinguishing between malignant and nonmalignant ascites showd that(1)serous CEA,CA19-9,CA72-4 and ascitic CEA were higher in malignant ascites than in non-malignant ascites,and the difference was statistically significant(P<0.05).AFP and CA125 were higher in malignant ascites than in non-malignant ascites,with no statistically significant difference(P>0.05).(2)The area under the ROC curve(AUC)of serous CEA,CA19-9 and CA72-4 and ascitic CEA in the diagnosis of malignant ascites were 0.708,0.746,0.827 and0.838,respectively.When the cut-off value of serous CEA was3.44ng/ml,the sensitivity and specificity were 50.7% and 92.3%,respectively.When the cut-off value of CA19-9 was 33.50U/ml,the sensitivity and specificity were 47.1% and 96.2%,respectively,and when the cut-off value of CA72-4 was 2.76U/ml,the sensitivity and specificity were 66.2%% and 91.3%,respectively.When the cut-off value of ascitic CEA was 1.82ng/ml,the sensitivity and specificity were 63.6%% and96.9%,respectively.5.The results of Tuberculous bacteria infects t-cell spots(TSPOT.TB)and ascitic exfoliated cells showd that 36 cases with tuberculous ascites and 32 cases with non-tuberculous ascites were tested by serous T-SPOT.TB,of 32 cases were positive in tuberculous ascites and 30 cases were negative in non-tuberculous ascites,the sensitivity and specificity were 86.1% and 93.7%.A total of 97 cases underwent ascitic exfoliation cytology,and the results shows that in the 60 cases withmalignant ascites,there was 36 cases founding cancer cells.No cancerous cells were found in 37 cases of non-malignant ascites,and the sensitivity and specificity was 60% and 100%,respectively.6.The results of subperitoneal puncture peritoneal biopsy and laparoscopy showd that a total of 9 patients completed subperitoneal puncture peritoneal biopsyand ultrasound-guided percutaneous peritoneal biopsy,and 8 cases were finally diagnosed,including 5 cases of peritoneal pseudomyxoma,1 case of tuberculous peritonitis,1 case of malignant mesothelioma,and 1 case of undet ermined etiology,the diagnosis rate was 88.9%.7 cases completed peritoneal biopsy,and 6cases were finally diagnosed by histopathology,including 1 case of ovarian follicular membrane fibroma,1 case of colon cancer,1 case of tuberculous peritonitis,1 case of pelvic serous adenocarcinoma,2 cases of intraperitoneal metastatic cancer,1 case of unclear cause,the diagnosis rate was 85.7%.Conclusion:1.Among the causes of ascites cause to be detemined that excluding cirrhosis,the first one is malignant ascites,followed by tuberculous ascites.2.Serum sedimentation,total protein of ascites and lactate dehydrogenase were significantly increased in malignant ascites and tuberculous ascites,there are certain reference value for the identification cause of ascites.Adenosine deaminase was significantly increased in tuberculous ascites,which was significant for differentiating tuberculous ascites from non-tuberculous ascites.3.Serous CEA,CA19-9,CA72-4 and ascitic CEA were significant for the identification of benign and malignant ascites,while AFP and CA125 were less significant for the identification of benign and malignant ascites.4.The sensitivity and specificity of serous T-SPOT.TB in the diagnosis of tuberculous ascites is high,and the sensitivity of ascitic exfoliated cells in the diagnosis of malignant ascites is low.5.Peritoneal biopsy have a high diagnosis rate,and are of great value for diagnosing intractable case. |
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