PCT、CRP、腹水乳铁蛋白及LBP联合检测在自发性细菌性腹膜炎患者诊断中的临床价值
|
摘要
目的分析降钙素原(PCT)、C反应蛋白(CRP)、腹水乳铁蛋白(LF)及脂多糖结合蛋白(LBP)水平变化在肝硬化合并自发性细菌性腹膜炎患者诊断中的临床价值。方法选取2016年5月至2017年12月在我院接受治疗的110例肝硬化患者作为研究对象,并根据是否并发SBP分为SBP组(55例)和非SBP组(55例)。分别检测两组患者肝功能相关指标,采用电化学发光法、免疫比浊法及酶联免疫吸附法检测两组患者PCT、CRP、腹水LF及LBP水平。运用ROC曲线评价各指标对SBP的诊断价值。结果 SBP组患者肝功能指标AST、ALT、TBIL及ALB与非SBP组相比差异均有统计学意义(P <0.05)。SBP组PCT、CRP、腹水LF及LBP水平均显著高于非SBP组,两组比较差异具有统计学意义(P <0. 05)。PCT、CRP、腹水LF及LBP的ROC曲线下面积(AUC)依次为0.735、0.831、0.706及0.812,四项指标联合检测AUC最大为0.926,显著高于其他各单项指标(P <0. 05)。四项指标联合检测的灵敏度为94.54%、阴性预测值为93.88%,均显著高于各单项指标的检测结果 (P <0.05)。结论 PCT、CRP、腹水LF及LBP联合检测可有效提高肝硬化患者合并自发性细菌性腹膜炎诊断的灵敏度和准确度,具有较高的临床参考价值。
Objective To analyze the clinical value of procalcitonin(PCT),C-reactive protein(CRP), ascites lactoferrin(LF) and lipopolysaccharide binding protein(LBP) levels in patients with spontaneous bacterial peritonitis. Methods A total of 110 patients with cirrhosis who were treated in our hospital from May,2016 to December,2017 were enrolled for the study. The patients were divided into the SBP group(55 cases) and non-SBP group(55 cases) according to whether they were concurrent with SBP. The liver function related indexes of the two groups were detected, respectively. The levels of PCT, CRP, ascites LF and LBP were detected by electrochemiluminescence, immunoturbidimetry and enzyme-linked immunosorbent assay. The ROC curve was used to evaluate the diagnostic value of each index for SBP. Results The liver function indexes of AST, ALT, TBIL and ALB in the SBP group were significantly different from those in the nonSBP group(P<0.05). The PCT, CRP, ascites LF and LBP levels in the SBP group were significantly higher than those in the non-SBP group( P < 0.05). The area under the ROC curve( AUC) of PCT,CRP, ascites LF and LBP were 0. 735,0. 831,0. 706 and 0. 812, respectively. The combined detection of four indicators showed an AUC of 0. 926, which was significantly higher than individual indicators(P <0. 05). The sensitivity of the combined detection of the four indicators was 94. 54%,and the negative predictive value was93.88%, which was significantly higher than the detection results of each individual index(P <0. 05).Conclusion The combined detection of PCT, CRP, ascites LF and LBP can effectively improve the sensitivity and accuracy of diagnosis of cirrhotic patients with spontaneous bacterial peritonitis,and has a relative higher clinical reference value.
Objective To analyze the clinical value of procalcitonin(PCT),C-reactive protein(CRP), ascites lactoferrin(LF) and lipopolysaccharide binding protein(LBP) levels in patients with spontaneous bacterial peritonitis. Methods A total of 110 patients with cirrhosis who were treated in our hospital from May,2016 to December,2017 were enrolled for the study. The patients were divided into the SBP group(55 cases) and non-SBP group(55 cases) according to whether they were concurrent with SBP. The liver function related indexes of the two groups were detected, respectively. The levels of PCT, CRP, ascites LF and LBP were detected by electrochemiluminescence, immunoturbidimetry and enzyme-linked immunosorbent assay. The ROC curve was used to evaluate the diagnostic value of each index for SBP. Results The liver function indexes of AST, ALT, TBIL and ALB in the SBP group were significantly different from those in the nonSBP group(P<0.05). The PCT, CRP, ascites LF and LBP levels in the SBP group were significantly higher than those in the non-SBP group( P < 0.05). The area under the ROC curve( AUC) of PCT,CRP, ascites LF and LBP were 0. 735,0. 831,0. 706 and 0. 812, respectively. The combined detection of four indicators showed an AUC of 0. 926, which was significantly higher than individual indicators(P <0. 05). The sensitivity of the combined detection of the four indicators was 94. 54%,and the negative predictive value was93.88%, which was significantly higher than the detection results of each individual index(P <0. 05).Conclusion The combined detection of PCT, CRP, ascites LF and LBP can effectively improve the sensitivity and accuracy of diagnosis of cirrhotic patients with spontaneous bacterial peritonitis,and has a relative higher clinical reference value.
引文
[1]吕震,张友祥.自发性细菌性腹膜炎的发病机制及治疗现状[J].中西医结合肝病杂志,2010,20(4):255-257.
[2] ENSARO G LU F, KORKMAZ M, GECKIL A(U|¨), et al. Factors affecting mortality and morbidity of patients with cirrhosis hospitalized for spontaneous bacterial peritonitis[J]. Exp Clin Transplant,2015,13(Suppl 3):131-136.
[3]黄利华,张英.自发性细菌性腹膜炎预防与治疗进展[J].实用肝脏病杂志,2014,17(4):348-351.
[4]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,2015,55(9):56-58.
[5] DRAGOSERRANO M E, CAMPOSRODRIGUEZ R, CARRERO J C,et al. Lactoferrin:balancing ups and downs of inflammation due to microbial infections[J]. Int J Mol Sci,2017,18(3):pii:E501.
[6] AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L,et al. High serum lipopolysaccharide binding protein is associated withincreased mortality in patients with decompensated cirrhosis[J].Liver Int,2017,37(4):576-582.
[7]中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[8] ANGELI P, LENZ K, GINES P, et al. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J]. J Hepatol,2010,53(3):397-417.
[9]吴玲,苏菲.自发性细菌性腹膜炎发病机制、诊治、预后进展[J].安徽医药,2010,14(12):1380-1383.
[10] CAI Z H,FAN C L, ZHENG J F, 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,2015,15:55.
[11] THALHEIMER U,TRIANTOS C K, SAMONAKIS D N, et al.Infection,coagulation, and variceal bleeding in cirrhosis[J]. Gut,2005,54(4):556-563.
[12]张兴光,冯志杰.肝硬化自发性细菌性腹膜炎的诊断及治疗进展[J].世界华人消化杂志,2015,23(3):388-395.
[13]王毓麟.肝硬化合并自发性细菌性腹膜炎相关因素分析及治疗对策[J].中华医院感染学杂志,2012,22(18):3990-3992.
[14]刘蓉华,林文源.PCT检测在感染性疾病中的应用进展[J].医学综述,2014,20(22):4106-4108.
[15] YANG Y, LI L, QU C, et al. Diagnostic accuracy of serum procalcitonin for spontaneous bacterial peritonitis due to end-stage liver disease:a meta-analysis[J]. Medicine(Baltimore),2015,94(49):e2077.
[16] PAPP M,VITALIS Z,ALTORJAY I,et al. Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections[J]. Liver Int,2012,32(4):603-611.
[17]刘锋,隆维东,朱艮苗.PCT及CRP对晚期肝病自发性细菌性腹膜炎患者的诊断及预后价值分析[J].胃肠病学和肝病学杂志,2017,26(9):1030-1032.
[18] PARSI M A, SAADEH S N, ZEIN N N, et al. Ascitic fluid lactoferrin for diagnosis of spontaneous bacterial peritonitis[J].Gastroenterology,2008,135(3):803-807.
[19]王志远,高峰.血清降钙素原与腹水乳铁蛋白在自发性细菌性腹膜炎患者中的临床价值[J].胃肠病学和肝病学杂志,2017,26(3):311-314.
[20]唐能源,陈伟庆.血清及腹水脂多糖结合蛋白检测在肝硬化自发性细菌性腹膜炎诊断中的意义[J].中华肝脏病杂志,2012,20(7):492-496.
[2] ENSARO G LU F, KORKMAZ M, GECKIL A(U|¨), et al. Factors affecting mortality and morbidity of patients with cirrhosis hospitalized for spontaneous bacterial peritonitis[J]. Exp Clin Transplant,2015,13(Suppl 3):131-136.
[3]黄利华,张英.自发性细菌性腹膜炎预防与治疗进展[J].实用肝脏病杂志,2014,17(4):348-351.
[4]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,2015,55(9):56-58.
[5] DRAGOSERRANO M E, CAMPOSRODRIGUEZ R, CARRERO J C,et al. Lactoferrin:balancing ups and downs of inflammation due to microbial infections[J]. Int J Mol Sci,2017,18(3):pii:E501.
[6] AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L,et al. High serum lipopolysaccharide binding protein is associated withincreased mortality in patients with decompensated cirrhosis[J].Liver Int,2017,37(4):576-582.
[7]中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324-329.
[8] ANGELI P, LENZ K, GINES P, et al. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J]. J Hepatol,2010,53(3):397-417.
[9]吴玲,苏菲.自发性细菌性腹膜炎发病机制、诊治、预后进展[J].安徽医药,2010,14(12):1380-1383.
[10] CAI Z H,FAN C L, ZHENG J F, 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,2015,15:55.
[11] THALHEIMER U,TRIANTOS C K, SAMONAKIS D N, et al.Infection,coagulation, and variceal bleeding in cirrhosis[J]. Gut,2005,54(4):556-563.
[12]张兴光,冯志杰.肝硬化自发性细菌性腹膜炎的诊断及治疗进展[J].世界华人消化杂志,2015,23(3):388-395.
[13]王毓麟.肝硬化合并自发性细菌性腹膜炎相关因素分析及治疗对策[J].中华医院感染学杂志,2012,22(18):3990-3992.
[14]刘蓉华,林文源.PCT检测在感染性疾病中的应用进展[J].医学综述,2014,20(22):4106-4108.
[15] YANG Y, LI L, QU C, et al. Diagnostic accuracy of serum procalcitonin for spontaneous bacterial peritonitis due to end-stage liver disease:a meta-analysis[J]. Medicine(Baltimore),2015,94(49):e2077.
[16] PAPP M,VITALIS Z,ALTORJAY I,et al. Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections[J]. Liver Int,2012,32(4):603-611.
[17]刘锋,隆维东,朱艮苗.PCT及CRP对晚期肝病自发性细菌性腹膜炎患者的诊断及预后价值分析[J].胃肠病学和肝病学杂志,2017,26(9):1030-1032.
[18] PARSI M A, SAADEH S N, ZEIN N N, et al. Ascitic fluid lactoferrin for diagnosis of spontaneous bacterial peritonitis[J].Gastroenterology,2008,135(3):803-807.
[19]王志远,高峰.血清降钙素原与腹水乳铁蛋白在自发性细菌性腹膜炎患者中的临床价值[J].胃肠病学和肝病学杂志,2017,26(3):311-314.
[20]唐能源,陈伟庆.血清及腹水脂多糖结合蛋白检测在肝硬化自发性细菌性腹膜炎诊断中的意义[J].中华肝脏病杂志,2012,20(7):492-496.