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

目的 探讨腹水及血浆降钙素原在肝硬化合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)诊断中的价值,为其早期诊断提供依据。方法 选取首都医科大学附属北京佑安医院2014年8月至2015年1月肝硬化腹水患者69例,其中确诊合并自发性细菌性腹膜炎的28例,未合并自发性细菌性腹膜炎的41例,进行腹水及血浆降钙素原水平检测,并进行相关统计分析。结果 与非SBP组相比,SBP组腹水降钙素原(procalcitonin,PCT)、腹水白细胞(white blood cell,WBC)、腹水多形核细胞(polymorphonuclear,PMN)和血浆PCT、全血WBC检测结果均显著升高,差异有统计学意义(P<0.01);同一患者同一病程时期腹水中PCT浓度与血浆PCT浓度基本一致,呈正相关,相关系数(r=0.877,P<0.01);诊断自发性细菌性腹膜炎时,血浆PCT和腹水PCT曲线下面积分别为0.919和0.820,最佳临界值分别为0.415 ng/mL和0.746 ng/mL。结论 腹水及血清降钙素原的检测对肝硬化腹水伴发自发性细菌性腹膜炎的早期诊断有重要价值,其具有很高的敏感性和特异性,且血浆PCT的诊断价值优于腹水PCT。

Values of ascites and plasma procalcitonin in diagnosis of liver cirrhosis with spontaneous bacterial peritonitis

Objective To explore the clinical value of ascites and plasma procalcitonin examination in early diagnosis of liver cirrhosis with spontaneous bacterial peritonitis(SBP). Methods Totally 69 cirrhotic patients with ascites including 28 patients with spontaneous bacterial peritonitis and 41 patients without spontaneous bacterial peritonitis seen in Beijing Youan Hospital from August, 2014 to January, 2015 were studied. The levels of ascites and plasma procalcitonin of these patients were analyzed. Results The levels of procalcitonin, white blood cell counts in plasma and procalcitonin, white blood cell, polymorphonuclear leucocytes counts in ascites in SBP group were significantly higher than those in the non-SBP group(P<0.01). The procalcitonin levels in ascites and plasma were positively correlated(r=0.877, P<0.01). ROC curve analysis showed that the areas under curve of ascites and plasma procalcitonin were 0.919 and 0.820; meanwhile the best thresholds were 0.415 and 0.746 ng/mL respectively. Conclusion Detections of ascites and plasma procalcitonin have significant value for the early diagnosis of liver cirrhosis patients with spontaneous bacterial peritonitis, it has high sensitivity and specificity, and the diagnostic value of plasma procalcitonin is superior to ascites procalcitonin.