SAA、LPS及PCT对肝硬化合并自发性细菌性腹膜炎的诊断特异性和敏感性分析
|
摘要
目的探讨联合检测血清淀粉样蛋白A(serum amyloid A,SAA)、脂多糖(lipopolysaccharide,LPS)及降钙素原(procallcitonin,PCT)对肝硬化合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的临床诊断价值。方法选取2016年8月至2017年7月于本院确诊的肝硬化患者60例纳入对照组、肝硬化合并SBP患者60例纳入观察组,分别检测两组患者血清SAA、LPS及PCT水平,并探讨三者联合检测对鉴别诊断肝硬化合并SBP的临床价值。结果观察组患者血清SAA、LPS及PCT水平均显著高于对照组(P_均<0.05)。当血清SAA临界值为30.96 mg/ml时,诊断肝硬化合并SBP的灵敏度为76.84%,特异度为85.11%,ROC曲线下面积(AUC)为0.831;当血清LPS临界值为68.24 pg/ml时,诊断肝硬化合并SBP的灵敏度为72.71%,特异度为80.30%,AUC为0.779;当血清PCT临界值为0.48 ng/ml时,诊断肝硬化合并SBP的灵敏度为84.26%,特异度为81.59%,AUC为0.862;联合检测血清SAA、LPS及PCT诊断肝硬化合并SBP的灵敏度为91.64%,特异度为95.77%,AUC为0.938。结论肝硬化合并SBP患者血清SAA、LPS及PCT水平均显著高于单纯肝硬化患者,三者联合检测对于鉴别诊断肝硬化合并SBP具有较高的临床价值。
Objective To investigate the clinical value of combined detection of serum amyloid A(SAA), lipopolysaccharide(LPS) and procallcitonin(PCT) in the differential diagnosis of spontaneous bacterial peritonitis(SBP) in patients with cirrhosis. Method 60 patients with liver cirrhosis were embedded in observation group and 60 patients with liver cirrhosis complicated with SBP were embedded in control group in our hospital from August 2016 to July 2017. Serum levels of SAA, LPS and PCT were measured in the two groups to explore the clinical value of combined detection of the three indexes in differential diagnosis of liver cirrhosis complicated with SBP. Result Serum SAA, LPS and PCT levels of observation group were significantly higher than those of control group(P_(all)< 0.05). When the critical value of serum SAA was 30.96 mg/ml, the sensitivity of diagnosis of liver cirrhosis combined with SBP was 76.84%, the specificity was 85.11%, the area under the curve(AUC) was 0.831; when the critical value of serum LPS was 68.24 pg/ml, the sensitivity of diagnosis of liver cirrhosis combined with SBP was 72.71%, the specificity was 80.30%, the AUC was 0.779; when the critical value of serum PCT was 0.48 ng/ml, the sensitivity of diagnosis of liver cirrhosis combined with SBP was 84.26%, the specificity was 81.59%, the AUC was 0.862; the sensitivity of combined detection of serum SAA, LPS and PCT in the diagnosis of liver cirrhosis combined with SBP was 91.64%, the specificity was 95.77%, the AUC was 0.938. Conclusion The levels of serum SAA, LPS and PCT in patients with cirrhosis combined with SBP are significantly higher than patients with simple liver cirrhosis. The combined detection of SAA, LPS and PCT has high clinical value in differential diagnosis of liver cirrhosis combined with SBP.
Objective To investigate the clinical value of combined detection of serum amyloid A(SAA), lipopolysaccharide(LPS) and procallcitonin(PCT) in the differential diagnosis of spontaneous bacterial peritonitis(SBP) in patients with cirrhosis. Method 60 patients with liver cirrhosis were embedded in observation group and 60 patients with liver cirrhosis complicated with SBP were embedded in control group in our hospital from August 2016 to July 2017. Serum levels of SAA, LPS and PCT were measured in the two groups to explore the clinical value of combined detection of the three indexes in differential diagnosis of liver cirrhosis complicated with SBP. Result Serum SAA, LPS and PCT levels of observation group were significantly higher than those of control group(P_(all)< 0.05). When the critical value of serum SAA was 30.96 mg/ml, the sensitivity of diagnosis of liver cirrhosis combined with SBP was 76.84%, the specificity was 85.11%, the area under the curve(AUC) was 0.831; when the critical value of serum LPS was 68.24 pg/ml, the sensitivity of diagnosis of liver cirrhosis combined with SBP was 72.71%, the specificity was 80.30%, the AUC was 0.779; when the critical value of serum PCT was 0.48 ng/ml, the sensitivity of diagnosis of liver cirrhosis combined with SBP was 84.26%, the specificity was 81.59%, the AUC was 0.862; the sensitivity of combined detection of serum SAA, LPS and PCT in the diagnosis of liver cirrhosis combined with SBP was 91.64%, the specificity was 95.77%, the AUC was 0.938. Conclusion The levels of serum SAA, LPS and PCT in patients with cirrhosis combined with SBP are significantly higher than patients with simple liver cirrhosis. The combined detection of SAA, LPS and PCT has high clinical value in differential diagnosis of liver cirrhosis combined with SBP.
引文
[1]李春英,邹金海,梁育飞,等.CD64、降钙素原检测在肝硬化自发性细菌性腹膜炎诊断中的意义[J].重庆医学,2015,17(28):3953-3955.
[2]吴红丽,孙岳枫.肝硬化伴自发性细菌性腹膜炎患者血浆PCT和CRP水平的变化及意义[J].山东医药,2015,26(9):56-58.
[3]中华医学会医学工程学分会干细胞工程专业学组.干细胞移植规范化治疗失代偿期肝硬化的专家共识[J].中华细胞与干细胞杂志(电子版),2014,4(4):1-5.
[4]刘晓红.美国肝病学会关于“肝硬化腹水伴自发性细菌性腹膜炎”的实践指南[J].中国实用内科杂志,2007,27(8):565-567.
[5]缪希莉,梅四清,高贵民.血清降钙素原联合炎症指标对慢性重型乙型肝炎合并自发性细菌性腹膜炎的诊断价值[J].广东医学,2016,37(17):2625-2628.
[6]Ho KJ,Duk JY,Young JI,et al.Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients With Cirrhosis[J].Medicine(Baltimore),2016,95(17):e3489.
[7]吴静,蒋凤,曾藤,等.降钙素原在晚期肝病自发性细菌性腹膜炎中的诊断价值[J].中国医学科学院学报,2014,36(1):37-41.
[8]Lahmer T,Brandl A,Rasch S,et al.Fungal Peritonitis:Underestimated Disease in Critically Ill Patients with Liver Cirrhosis and Spontaneous Peritonitis[J].PLoS One,2016,11(7):e0158389.
[9]张晓苹,赵宏军,马阿火,等.自发性细菌性腹膜炎患者可溶性髓样细胞触发受体1表达研究[J].中国全科医学,2017,20(14):1684-1688.
[10]Dam G,Vilstrup H,Watson H,et al.Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites[J].Hepatology,2016,64(4):1265-1272.
[11]李进,胡振斌,李月翠.肝硬化患者自发性细菌性腹膜炎腹水感染的相关因素分析[J].中华医院感染学杂志,2014,18(21):5347-5349.
[12]喻安银,刘需祥,黄泳,等.血清降钙素原与血清淀粉样蛋白A和白细胞介素-8诊断肝硬化腹水感染的研究[J].中华医院感染学杂志,2017,27(20):4584-4587.
[13]黄允,李艳,彭锐,等.HBV感染致肝损伤患者CRP,hsCRP和SAA临床价值的探讨[J].现代检验医学杂志,2017,32(2):49-52.
[14]Cai ZH,Fan CL,Zheng JF,et al.Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J].BMC Infect Dis,2015,15(1):55.
[15]李倩.肝硬化败血症患者血清PCT水平变化分析[J].肝脏,2016,21(8):663-665.
[16]张燕,王全楚,李娜.血清PCT检测在肝硬化合并自发性细菌性腹膜炎分级诊疗中的应用价值[J].胃肠病学和肝病学杂志,2016,25(6):663-665.
[17]景富春,张素梅,高英,等.血清PCT与CRP检测在肝硬化并肺部感染患者诊治中的临床价值[J].检验医学与临床,2016,13(11):1457-1458.
[18]王嘉榕,李燕,孙红宾.脂多糖--针对革兰阴性菌的药物靶标[J].生物医学工程学杂志,2015,32(4):910-913.
[19]许垚,马帅,丁峰.抗菌肽在脓毒症治疗中的应用进展[J].上海交通大学学报(医学版),2017,37(8):1161-1164.
[20]Lankelma JM,Cranendonk DR,Belzer C,et al.Antibioticinduced gut microbiota disruption during human endotoxemia:a randomised controlled study[J].Gut,2017,66(9):1623-1630.
[2]吴红丽,孙岳枫.肝硬化伴自发性细菌性腹膜炎患者血浆PCT和CRP水平的变化及意义[J].山东医药,2015,26(9):56-58.
[3]中华医学会医学工程学分会干细胞工程专业学组.干细胞移植规范化治疗失代偿期肝硬化的专家共识[J].中华细胞与干细胞杂志(电子版),2014,4(4):1-5.
[4]刘晓红.美国肝病学会关于“肝硬化腹水伴自发性细菌性腹膜炎”的实践指南[J].中国实用内科杂志,2007,27(8):565-567.
[5]缪希莉,梅四清,高贵民.血清降钙素原联合炎症指标对慢性重型乙型肝炎合并自发性细菌性腹膜炎的诊断价值[J].广东医学,2016,37(17):2625-2628.
[6]Ho KJ,Duk JY,Young JI,et al.Predictive Factors of Spontaneous Bacterial Peritonitis Caused by Gram-Positive Bacteria in Patients With Cirrhosis[J].Medicine(Baltimore),2016,95(17):e3489.
[7]吴静,蒋凤,曾藤,等.降钙素原在晚期肝病自发性细菌性腹膜炎中的诊断价值[J].中国医学科学院学报,2014,36(1):37-41.
[8]Lahmer T,Brandl A,Rasch S,et al.Fungal Peritonitis:Underestimated Disease in Critically Ill Patients with Liver Cirrhosis and Spontaneous Peritonitis[J].PLoS One,2016,11(7):e0158389.
[9]张晓苹,赵宏军,马阿火,等.自发性细菌性腹膜炎患者可溶性髓样细胞触发受体1表达研究[J].中国全科医学,2017,20(14):1684-1688.
[10]Dam G,Vilstrup H,Watson H,et al.Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites[J].Hepatology,2016,64(4):1265-1272.
[11]李进,胡振斌,李月翠.肝硬化患者自发性细菌性腹膜炎腹水感染的相关因素分析[J].中华医院感染学杂志,2014,18(21):5347-5349.
[12]喻安银,刘需祥,黄泳,等.血清降钙素原与血清淀粉样蛋白A和白细胞介素-8诊断肝硬化腹水感染的研究[J].中华医院感染学杂志,2017,27(20):4584-4587.
[13]黄允,李艳,彭锐,等.HBV感染致肝损伤患者CRP,hsCRP和SAA临床价值的探讨[J].现代检验医学杂志,2017,32(2):49-52.
[14]Cai ZH,Fan CL,Zheng JF,et al.Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J].BMC Infect Dis,2015,15(1):55.
[15]李倩.肝硬化败血症患者血清PCT水平变化分析[J].肝脏,2016,21(8):663-665.
[16]张燕,王全楚,李娜.血清PCT检测在肝硬化合并自发性细菌性腹膜炎分级诊疗中的应用价值[J].胃肠病学和肝病学杂志,2016,25(6):663-665.
[17]景富春,张素梅,高英,等.血清PCT与CRP检测在肝硬化并肺部感染患者诊治中的临床价值[J].检验医学与临床,2016,13(11):1457-1458.
[18]王嘉榕,李燕,孙红宾.脂多糖--针对革兰阴性菌的药物靶标[J].生物医学工程学杂志,2015,32(4):910-913.
[19]许垚,马帅,丁峰.抗菌肽在脓毒症治疗中的应用进展[J].上海交通大学学报(医学版),2017,37(8):1161-1164.
[20]Lankelma JM,Cranendonk DR,Belzer C,et al.Antibioticinduced gut microbiota disruption during human endotoxemia:a randomised controlled study[J].Gut,2017,66(9):1623-1630.