• 作者： 台北榮民總醫院內科部胃腸科暨國立陽明大學; 台北榮民總醫院內科部過敏免疫風濕科; 國立陽明大學醫學院
• 作者服務機構： 王聖賢; 李發耀; 趙毅; 陳俊嘉; 林孝義; 吳淑玲; 李壽東
• 中文摘要： 　　為探討腹水補體之臨床價值，於為期二年間測定36位腹膜癌症病患，65位肝癌病患，110位無菌肝硬化腹水病患，31位自發性細菌性腹膜炎病患以及12位其他各式疾病病患（4位腎病症後群、3位紅斑性狼蒼、2位續發性腹膜炎、1位心因性腹水，1位嗜伊紅性腹膜炎及1位結核性腹膜炎）之腹水補體3c及補體4濃度。腹膜癌症病患的腹水補體3c及補體4的濃度（32.8士10.4及13.4士7.4mg/dL）高於無菌性肝硬化腹水（9.2±5.2及4.5±3.9mg/dL，p＜0.001），自發性細菌性腹膜炎病患（8.2±4.1及3.8±2.4mg/dL，p＜0.001）或肝癌病患（12.8±8.3及5.6±4.4mg/dL，p＜0.001），但與其他各式疾病病患無統計學上之差異。採用腹水補體3c濃度高於界限值(20mg/dL)以診斷腹膜癌症，其敏感度為83.3％，特異度為92.7％及精確度為90.9％；而採用補體4濃度高於界限值(10mg/dL)，其敏感度為60.4％，特異度為89.8％及精確度為84.3％。腹水蛋白與腹水補體3c(r＝0.7)或補體4(r＝0.57)濃度呈正相關。我們的結論是測定腹水補體濃度為臨床上證明腹水非源於肝病之有效輔助工具，然而，對於自發性細菌性腹膜炎或肝癌的診斷價值甚低。
• 英文摘要： In a two-year period, ascitic fluid concentrations of complement 3c and complement 4 weremeasured in 110 patients with sterile cirrhotic ascites, 31 patients with spontaneous bacterial peritonitis,65 patients with hepatocellular carcinoma, 36 patients with peritoneal carcinomatosis and 12 patients withmiscellaneous diseases (nephrotic syndrome 4, systemic lupus erythematosus 3, secondary peritonitis 2,cardiac ascites 1, eosinophilic peritonitis 1 and tuberculosis peritonitis 1) to assess the clinical utility ofascitic fluid complements. The ascitic fluid level of complement 3c or C4 was significantly higher inpatients with peritoneal carcinomatosis (32.8 ± 10.2, 13.4 ± 7.4 mg/dL) than in patients with sterile cir-rhotic ascites (9.2 ± 5.2, 4.5 ± 3.9 mg/dL, p < 0.001), spontaneous bacterial peritonitis (8.2 ± 4.1, 3.8 ± 2.4mg/dL, p < 0.001) or hepatocellular carcinoma（12.8 ± 8.3, 5.6 ± 4.4 mg/dL, p < 0.001). However, it wasnot significantly different from the miscellaneous disease group. To verify that ascites formation is notrelated to liver disease origin, diagnostic sensitivity, specificity and accuracy were 83.3%, 92.7% and90.9%, respectively, by the ascitic fluid level of complement 3c higher than the cut-off value (20 mg/dl);or 60.4%, 89.8% and 84.3%, respectively, by the ascitic fluid level of complement 4 higher than the cut-offvalue (10 mg/dL). A direct correlation was found between the ascitic fluid protein level and the asciticfluid complement 3c (r = 0.70) or complement 4 (r = 0.57) level. Based on results in this study, we can con-clude that measuring ascitic fluid complements is clinically useful in disapproving the liver disease originof ascites formation. However, it is of little value in diagnosing spontaneous bacterial peritonitis or hepato-cellular carcinoma.
• 中文關鍵字： ascitic fluid; cirrhosis; complements; diagnostic paracentesis; malignancy.
• 英文關鍵字： --