血清及腹水中CRP、PCT、MCP-1、TNF-α、IL-6水平对肝硬化并发自发性细菌性腹膜炎中的诊断及其预后分析
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摘要
[目的]探讨血清及腹水中CRP、PCT、MCP-1、TNF-α、IL-6水平对肝硬化并发自发性细菌性腹膜炎中的诊断及其预后分析。[方法]选择2015年11月～2018年11月在我院就诊的128例肝硬化患者,采用ELISA法检测血清和腹水中CRP、PCT、MCP-1、TNF-α和IL-6水平,评估其在诊断及预后中的作用。[结果]合并SBP组患者治疗前血清及腹水CRP、PCT、MCP-1、TNF-α和IL-6水平明显高于未合并SBP组(P<0.05),经抗感染治疗后,合并SBP组患者血清及腹水CRP、PCT、MCP-1、TNF-α和IL-6水平较治疗前均明显降低(P<0.05)。诊断SBP特异性、敏感性方面联合检测高于单一项目检测(P<0.05)。64例合并SBP组患者在治疗1个月后好转41例,恶化23例。好转组血清及腹水CRP、PCT、MCP-1、TNF-α和IL-6水平明显低于恶化组(P<0.05)。[结论]血清和腹水CRP、PCT、MCP-1、TNF-α和IL-6水平可作为早期诊断肝硬化合并SBP和判断预后的敏感性实验室指标。
[Objective]To investigate the diagnosis and prognostic analysis of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 levels in patients with liver cirrhosis complicated with spontaneous bacterial peritonitis.[Methods]128 patients with liver cirrhosis selected from November 2015 to November 2018 in our hospital.The levels of CRP,PCT,MCP-1,TNF-α and IL-6 in serum and ascites were detected by ELISA,and their roles in diagnosis and prognosis were evaluated.[Results]Before treatment,the levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 in SBP patients were significantly higher than those in non-SBP group(P<0.05).After anti-infective treatment,the levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 in SBP patients were significantly lower than those before treatment(P<0.05).The specificity and sensitivity of combined detection in the diagnosis of SBP were higher than that of single item detection(P<0.05).Among 64 cases of SBP,there were 41 cases improved and 23 cases worsened after one month of treatment.The levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 in the improved group were significantly lower than those in the worsening group(P<0.05).[Conclusion]The levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 can be used as sensitive laboratory indicators for early diagnosis of cirrhosis complicated with SBP and predicting prognosis.
[Objective]To investigate the diagnosis and prognostic analysis of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 levels in patients with liver cirrhosis complicated with spontaneous bacterial peritonitis.[Methods]128 patients with liver cirrhosis selected from November 2015 to November 2018 in our hospital.The levels of CRP,PCT,MCP-1,TNF-α and IL-6 in serum and ascites were detected by ELISA,and their roles in diagnosis and prognosis were evaluated.[Results]Before treatment,the levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 in SBP patients were significantly higher than those in non-SBP group(P<0.05).After anti-infective treatment,the levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 in SBP patients were significantly lower than those before treatment(P<0.05).The specificity and sensitivity of combined detection in the diagnosis of SBP were higher than that of single item detection(P<0.05).Among 64 cases of SBP,there were 41 cases improved and 23 cases worsened after one month of treatment.The levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 in the improved group were significantly lower than those in the worsening group(P<0.05).[Conclusion]The levels of serum and ascites CRP,PCT,MCP-1,TNF-α and IL-6 can be used as sensitive laboratory indicators for early diagnosis of cirrhosis complicated with SBP and predicting prognosis.
引文
[1] 刘密霞,李建国,孔鹏北,等.乙肝肝硬化并自发性细菌性腹膜炎预后因素分析及预后模型建立[J].中国中西医结合消化杂志,2017,5(11):33-37.
[2] 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.
[3] 霍江波,于淑霞.血清Hs-CRP与PCT联合检测对肝硬化腹水合并自发性细菌性腹膜炎的诊断价值[J].胃肠病学和肝病学杂志,2017,26(8):930-933.
[4] 肖芳,陈鹏.血必净注射液联合头孢哌酮钠舒巴坦钠治疗乙型肝炎肝硬化并发自发性细菌性腹膜炎的疗效及对肠道黏膜屏障、炎性因子的影响[J].现代中西医结合杂志,2018,27(15):1643-1646.
[5] 刘英娇,王拱辰.单核细胞趋化蛋白-1与慢性肝病及并其发症的相关性[J].中国肝脏病杂志(电子版),2017,9(4):31-37.
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[7] 吴学朕,王永良,罗浩元,等.利用ROC曲线分析PCT对肝硬化并发自发性细菌性腹膜炎的诊断价值[J].国际检验医学杂志,2016,45(14):572-578.
[8] 刘娟,凌颖,袁聪,等.血清降钙素原在肝硬化并发自发性细菌性腹膜炎中的诊断及预后评估价值研究[J].湖南师范大学学报(医学版),2018,15(1):64-67.
[9] 朱燕莉,张海,饶德利.肝硬化合并自发性细菌性腹膜炎患者外周血中性粒细胞CD64表达变化的临床意义研究[J].中国中西医结合消化杂志,2017,7(4):54-56.
[10] 宋书宁,李清,马艳会,等.血清降钙素原在肝硬化并发自发性细菌性腹膜炎患者中的变化分析[J].基层医学论坛,2017,21(2):131-132.
[11] 刘德福.乙肝肝硬化腹水中TNF-α表达水平对转归的预测价值研究[J].标记免疫分析与临床,2018,25(6):800-803.
[12] Güne? H,Mete R,Aydin M,et al.Relationsbip among MIF,MCP-1,Viral loads,and HBs Ag leVels in chronic hepatjtis B patients[J].Turk J Med Sci,2015,45(3):634-637.
[13] Grzegorzewska AE,Pajzderski D,Sowiska A,et aI.Monocyte chemoattractant protein-1 gene(MCP-1-2518 A/G)p01 ymorphism and semlogical markers of hepatitis B vims infection in hemodialysis Patlents[J].Med Sci Monit,2014,20(7):1101-1116.
[14] 童芳芳.肝硬化并发自发性细菌性腹膜炎患者血清与腹水TNF-α、IL-6和IL-8水平差异比较[J].实用肝脏病杂志,2015,20(2):816-818.
[15] 陈思瑾,秦榕,高建鹏.自身抗体与血浆炎症因子联合检测对肝硬化合并肝功能衰竭的诊断价值[J].标记免疫分析与临床,2017,24(8):859-861,866.
[2] 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.
[3] 霍江波,于淑霞.血清Hs-CRP与PCT联合检测对肝硬化腹水合并自发性细菌性腹膜炎的诊断价值[J].胃肠病学和肝病学杂志,2017,26(8):930-933.
[4] 肖芳,陈鹏.血必净注射液联合头孢哌酮钠舒巴坦钠治疗乙型肝炎肝硬化并发自发性细菌性腹膜炎的疗效及对肠道黏膜屏障、炎性因子的影响[J].现代中西医结合杂志,2018,27(15):1643-1646.
[5] 刘英娇,王拱辰.单核细胞趋化蛋白-1与慢性肝病及并其发症的相关性[J].中国肝脏病杂志(电子版),2017,9(4):31-37.
[6] 王昱良,郑永青,吕歆,等.血必净注射液联合亚胺培南治疗肝硬化并发自发性细菌性腹膜炎的临床研究[J].现代药物与临床,2015,30(12):455-456.
[7] 吴学朕,王永良,罗浩元,等.利用ROC曲线分析PCT对肝硬化并发自发性细菌性腹膜炎的诊断价值[J].国际检验医学杂志,2016,45(14):572-578.
[8] 刘娟,凌颖,袁聪,等.血清降钙素原在肝硬化并发自发性细菌性腹膜炎中的诊断及预后评估价值研究[J].湖南师范大学学报(医学版),2018,15(1):64-67.
[9] 朱燕莉,张海,饶德利.肝硬化合并自发性细菌性腹膜炎患者外周血中性粒细胞CD64表达变化的临床意义研究[J].中国中西医结合消化杂志,2017,7(4):54-56.
[10] 宋书宁,李清,马艳会,等.血清降钙素原在肝硬化并发自发性细菌性腹膜炎患者中的变化分析[J].基层医学论坛,2017,21(2):131-132.
[11] 刘德福.乙肝肝硬化腹水中TNF-α表达水平对转归的预测价值研究[J].标记免疫分析与临床,2018,25(6):800-803.
[12] Güne? H,Mete R,Aydin M,et al.Relationsbip among MIF,MCP-1,Viral loads,and HBs Ag leVels in chronic hepatjtis B patients[J].Turk J Med Sci,2015,45(3):634-637.
[13] Grzegorzewska AE,Pajzderski D,Sowiska A,et aI.Monocyte chemoattractant protein-1 gene(MCP-1-2518 A/G)p01 ymorphism and semlogical markers of hepatitis B vims infection in hemodialysis Patlents[J].Med Sci Monit,2014,20(7):1101-1116.
[14] 童芳芳.肝硬化并发自发性细菌性腹膜炎患者血清与腹水TNF-α、IL-6和IL-8水平差异比较[J].实用肝脏病杂志,2015,20(2):816-818.
[15] 陈思瑾,秦榕,高建鹏.自身抗体与血浆炎症因子联合检测对肝硬化合并肝功能衰竭的诊断价值[J].标记免疫分析与临床,2017,24(8):859-861,866.