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복수의 감별진단에 있어서 혈청과 복수 알부민 농도차(serum-ascites albumin gradient: SAAG) 및 복수내 ferritin 농도 측정의 의의

복수의 감별진단에 있어서 혈청과 복수 알부민 농도차(serum-ascites albumin gradient: SAAG) 및 복수내 ferritin 농도 측정의 의의
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Clinical value of serum-ascites albumin gradient and ascitic fluid ferritin concentration in differential diagnosis of ascities
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대학원 의학과
이화여자대학교 대학원
The differential diagnosis of ascites is very important since precise diagnosis leads to different treatment plan and prognosis. A difference of more than 1.1 g/dl between the concentrations of albumin in serum and ascitic fluid (serum-ascites albumin gradient; SAAG) has been reported to be a superior index than transudate ascites for reflecting portal hypertension and differentiating benign ascites from malignant ascites. On the other hand, the serum ferritin levels are often elevated in patients with certain tumors and the ascites. It is particularly helpful in distinguishing cirrhotic ascites from ascites associated with primary or metastatic liver disease. However, correlation of SAAG and malignant ascites was poor in some reports and, to our knowledge, ascitic ferritin concentration has been rarely reported. Thus this study was designed in order to determine diagnostic values of SAAG and ascitic fluid ferritin concentration for differential diagnosis of ascites. Thirty one patients wiith ascites were studied by diagnostic paracentesis. The underlying diseases were 15 cases of cirrhosis, 9 cases of hepatocellular carcinoma(HCC) and 7 cases of carcinomatosis peritonei. The SAAG and ascitic fluid ferritin concentration, ascitic fluid total protein, lactic dehydrogenase(LDH), cholesterol, glucose, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) were measured to evaluate the accuracy in the differential diagnosis of ascites. 1. Comparing laboratory findings of ascites in patients with cirrhosis, HCC and carcinomatosis peritonei, the total protein and cholesterol concentrations of ascitic fluid were higher in HCC and carcinomatosis peritonei than in cirrhosis (hepatocellular carcinoma vs. cirrhosis, p<0.05 ; carcinomatosis peritonei vs. cirrhosis, p<0.05) ; ascitic fluid glucose concentration was lower and serum-ascites LDH ratio higher in carcinomatosis peritonei than in cirrhosis(cirrhosis vs. carcinomatosis peritonei, p<0.05 ; hepatocellular carcinoma vs. carcinomatosis Peritonei, p<0.05). The ascitic fluid AFP value was highest in HCC, and the ascitic fluid CEA highest in carcinomatosis peritonei, but there was no statistical significance. 2. The measured SAAG value were 2.0±0.6 g/dl in cirrhosis, 1.8±0.5 g/dl in HCC and 1.0±0.3 g/dl in carcinomatosis peritonei, showing a significant difference between liver disease-related ascites such as liver cirrhosis and HCC, and peritoneal disease-associated ascites such as carcinomatosis peritonei(p
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