血清肝素结合蛋白在肝硬化腹水自发性细菌性腹膜炎诊断中的意义
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摘要
[目的]探讨血清肝素结合蛋白(HBP)在肝硬化腹水发生自发性细菌性腹膜炎(SBP)诊断中的价值。[方法]选取2016年2月～2018年3月我院消化内科收治的肝硬化腹水患者182例为研究对象。根据肝硬化腹水是否发生SBP将182例患者分为SBP组(n=67例)和非SBP组(n=115例)。比较2组血清HBP、降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)和肝功能(白蛋白(ALB)、谷丙转氨酶(ALT));采用Pearson相关分析肝硬化腹水患者血清HBP水平和实验室指标间的相关性;采用受试者特征曲线(ROC)评估血清HBP对肝硬化腹水患者发生SBP的诊断价值。[结果]SBP组血清HBP、PCT、CRP高于非SBP组,血清ALB低于非SBP组(P <0.05);肝硬化腹水患者血清HBP与血清PCT、CRP呈正关性(P<0.05);肝硬化腹水患者血清HBP与血清ALB呈负相关(P<0.05);血清HBP水平对肝硬化腹水患者发生SBP预测的ROC曲线下总面积为0.949,在此曲线上最佳的阈值为11.82ng/ml,灵敏度为94.00%,特异度为83.50%。[结论]血清HBP水平对肝硬化腹水患者继发SBP的早期诊断具有重要的临床价值。
[Objective]To explore diagnostic value of serum spontaneous bacterial peritonitis for spontaneousbacterial peritonitis in patients with liver cirrhosis ascites.[Methods]182 patients with liver cirrhosis ascites admitted to the Department of Gastroenterology of the first people's hospital of Yibin from February 2016 to March 2018 were selected as subjects.According to whether SBP occurred in cirrhosis ascites,182 patients were divided into group SBP(n=67 cases)and non SBP group(n=115 cases).Serum HBP,procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC)and liver function(albumin(ALB),alanine aminotransferase(ALT)were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between serum HBP level and laboratory indexes in patients with liver cirrhosis ascites.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of serum HBP for SBP in patients with ascites due to cirrhosis.[Results]Serum HBP,PCT and CRP in group SBP were higher than those in non SBP group,and serum ALB level was lower than that in non SBP group(P<0.05).There was positive correlation between serum HBP and serum PCT and CRP in patients with liver cirrhosis ascites(P<0.05).There was a negative correlation between serum HBP and serum ALB in patients with liver cirrhosis ascites(P<0.05).The ROC curve area(AUC)of the serum HBP to predict SBP is 0.949.The best threshold is 11.82 ng/mL.The sensitivity is 94.00%.The specificity is 83.50%.[Conclusion]Serum HBP level has important clinical value in the early diagnosis of SBP in patients with cirrhosis ascites.
[Objective]To explore diagnostic value of serum spontaneous bacterial peritonitis for spontaneousbacterial peritonitis in patients with liver cirrhosis ascites.[Methods]182 patients with liver cirrhosis ascites admitted to the Department of Gastroenterology of the first people's hospital of Yibin from February 2016 to March 2018 were selected as subjects.According to whether SBP occurred in cirrhosis ascites,182 patients were divided into group SBP(n=67 cases)and non SBP group(n=115 cases).Serum HBP,procalcitonin(PCT),C-reactive protein(CRP),white blood cell count(WBC)and liver function(albumin(ALB),alanine aminotransferase(ALT)were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between serum HBP level and laboratory indexes in patients with liver cirrhosis ascites.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of serum HBP for SBP in patients with ascites due to cirrhosis.[Results]Serum HBP,PCT and CRP in group SBP were higher than those in non SBP group,and serum ALB level was lower than that in non SBP group(P<0.05).There was positive correlation between serum HBP and serum PCT and CRP in patients with liver cirrhosis ascites(P<0.05).There was a negative correlation between serum HBP and serum ALB in patients with liver cirrhosis ascites(P<0.05).The ROC curve area(AUC)of the serum HBP to predict SBP is 0.949.The best threshold is 11.82 ng/mL.The sensitivity is 94.00%.The specificity is 83.50%.[Conclusion]Serum HBP level has important clinical value in the early diagnosis of SBP in patients with cirrhosis ascites.
引文
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[10]杨丽霞,张伦理.肝硬化合并自发性细菌性腹膜炎早期诊断的研究进展[J].江西医药,2017,52(10):1098-1101.
[11]陆琳.肝硬化腹水并发自发性细菌性腹膜炎的危险因素[J].中国医药导报,2016,13(8):140-142.
[12]Kim JJ,Tsukamoto MM,Mathur AK,et al.Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis[J].Am J Gastroenterol,2014,109(9):1436-1442.
[13]党燕,张立丽,娄金丽,等.腹水及血浆降钙素原在肝硬化合并自发性细菌性腹膜炎诊断中的价值[J].实用医学杂志,2015,36(4):597-600.
[14]焦栓林,赵晓蕊,欧阳洪,等.降钙素原在肝硬化合并细菌性腹膜炎中的临床意义[J].肝脏,2018,23(2):145-147.
[15]朱龙川,朱萱.血降钙素原和C-反应蛋白对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎的诊断意义[J].中华消化杂志,2016,36(3):161-166.
[16]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.
[17]刘玉玲,冯振清,贾秋龙,等.乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清白蛋白和肝纤维化指标的变化[J].实用肝脏病杂志,2017,20(3):356-357.
[18]Guevara M,Terra C,Nazar A,et al.Albumin for bacterial infectionsinfections other than spontaneous bacterial peritonitis in cirrhosis.A randomized,controlled study[J].J Hepatol,2012,57(57):759-765.
[19]Bentzer P,Fisher J,Hyejin JK,et al.Erratum to:Heparinbinding protein is important for vascular leak in sepsis[J].Intensive Care Med Exp,2017,5(1):6-6.
[20]Fisher J,Russell JA,Bentzer P,et al.Heparin-Binding Protein(HBP):A Causative Marker and Potential Target for Heparin Treatment of Human Sepsis-Induced Acute Kidney Injury[J].Shock,2017,48(3):313-320.
[21]王卓,纪卫华,王雨新,等.肝素结合蛋白在新生儿早期细菌感染性疾病诊断中的应用价值[J].中华检验医学杂志,2016,39(12):972-973.
[2]张娟,孙伟,张维,等.血降钙素原联合中性粒细胞比例对肝病自发性细菌性腹膜炎的诊断意义[J].第三军医大学学报,2017,39(11):1159-1164.
[3] Adam L,Ryan A,Boyd JH,et al.Heparin-Binding Protein Measurement Improves the Prediction of Severe Infection with Organ Dysfunction in the Emergency Department[J].Crit Care Med,2015,43(11):2378-2386.
[4]邓宽国,韩相卿,王立民,等.血清肝素结合蛋白检测对ICU危重患者细菌感染的评价价值研究[J].中国临床医生杂志,2018,46(2):169-171.
[5] Lertdumrongluk K,Thongmee T,Kerr S J,et al.Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis[J].Eur J Pediatr,2015,174(1):43-48.
[6]喻文,罗红敏.肝素结合蛋白检测可提高急诊对严重脓毒症导致器官功能障碍的预测水平[J].中华危重病急救医学,2016,28(2):152-152.
[7]全国第十次病毒性肝炎及肝病学术会议.病毒性肝炎及肝病的诊断标准[J].中华传染病杂志,2001,19(1):53-53.
[8] European Association for the Study of the Liver.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]窦晓光.肝硬化并发自发性细菌性腹膜炎的诊断与治疗[J].中华肝脏病杂志,2008,16(6):406-410.
[10]杨丽霞,张伦理.肝硬化合并自发性细菌性腹膜炎早期诊断的研究进展[J].江西医药,2017,52(10):1098-1101.
[11]陆琳.肝硬化腹水并发自发性细菌性腹膜炎的危险因素[J].中国医药导报,2016,13(8):140-142.
[12]Kim JJ,Tsukamoto MM,Mathur AK,et al.Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis[J].Am J Gastroenterol,2014,109(9):1436-1442.
[13]党燕,张立丽,娄金丽,等.腹水及血浆降钙素原在肝硬化合并自发性细菌性腹膜炎诊断中的价值[J].实用医学杂志,2015,36(4):597-600.
[14]焦栓林,赵晓蕊,欧阳洪,等.降钙素原在肝硬化合并细菌性腹膜炎中的临床意义[J].肝脏,2018,23(2):145-147.
[15]朱龙川,朱萱.血降钙素原和C-反应蛋白对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎的诊断意义[J].中华消化杂志,2016,36(3):161-166.
[16]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.
[17]刘玉玲,冯振清,贾秋龙,等.乙型肝炎肝硬化并发自发性细菌性腹膜炎患者血清白蛋白和肝纤维化指标的变化[J].实用肝脏病杂志,2017,20(3):356-357.
[18]Guevara M,Terra C,Nazar A,et al.Albumin for bacterial infectionsinfections other than spontaneous bacterial peritonitis in cirrhosis.A randomized,controlled study[J].J Hepatol,2012,57(57):759-765.
[19]Bentzer P,Fisher J,Hyejin JK,et al.Erratum to:Heparinbinding protein is important for vascular leak in sepsis[J].Intensive Care Med Exp,2017,5(1):6-6.
[20]Fisher J,Russell JA,Bentzer P,et al.Heparin-Binding Protein(HBP):A Causative Marker and Potential Target for Heparin Treatment of Human Sepsis-Induced Acute Kidney Injury[J].Shock,2017,48(3):313-320.
[21]王卓,纪卫华,王雨新,等.肝素结合蛋白在新生儿早期细菌感染性疾病诊断中的应用价值[J].中华检验医学杂志,2016,39(12):972-973.