腹水中肝素结合蛋白及降钙素原对肝硬化腹水伴自发性细菌性腹膜炎的诊断价值

目的探讨腹水中的肝素结合蛋白(HBP)联合血清降钙素原(PCT)对自发性细菌性腹膜炎(SBP)的诊断价值。方法收集南昌大学第一附属医院2016年1月-2018年6月住院的腹水患者120例,分为肝硬化腹水伴SBP组(40例)、漏出性腹水组(40例)、癌性腹水组(20例)和结核性腹水组(20例),纳入患者全部进行腹水培养,测定并统计分析腹水多形核白细胞、腹水HBP和血清PCT水平。符合正态分布的计量资料两组间比较采用独立样本t检验;非正态分布数据多组间比较用Kruskal-Wallis H检验,组间两两比较用Nemenyi检验;腹水HBP、血清PCT诊断效能分析采用受试者工作特征(ROC)曲线分析,腹水HBP、血清PCT相关性采用Spearman分析。结果肝硬化腹水伴SBP组腹水HBP浓度及血清PCT浓度与其余3组(漏出性腹水组、癌性腹水组、结核性腹水组)比较均显著升高(P值均<0.05)。腹水细菌培养病原学阳性的不同菌种间腹水HBP水平无差异,腹水细菌培养阳性与阴性患者的HBP水平差异无统计学意义[(58.59±36.23) ng/ml vs (63.61±32.54) ng/ml,t=1.763,P> 0.05)。血清PCT诊断SBP的ROC曲线下面积为0.831,当取血清PCT诊断SBP的最佳临界值为0.62 ng/ml时,敏感度为86.3%,特异度为52.8%。腹水HBP诊断SBP的ROC曲线下面积为0.962,当取诊断SBP的最佳临界值为23.54 ng/ml时,敏感度为92.3%,特异度为65.4%,腹水HBP与血清PCT之间具有高度相关性(r=0.776,P <0.05)。结论腹水HBP的检测在SBP的诊断中有较高的价值,与传统的血清PCT联合检测可提高SBP的诊断效能。

Value of heparin-binding protein in ascites and serum procalcitonin in diagnosis of spontaneous bacterial peritonitis

Objective To investigate the value of heparin-binding protein(HBP) in ascites combined with serum procalcitonin(PCT) in the diagnosis of spontaneous bacterial peritonitis(SBP).Methods A total of 120 patients with ascites who were hospitalized in our hospital from January 2016 to June 2018 were enrolled and divided into cirrhotic ascites + SBP group with 40 patients,leaky ascites group with 40 patients,malignant ascites group with 20 patients,and tuberculous ascites group with 20 patients.Bacterial culture of ascites was performed for all patients,and polymorphonuclear leukocyte(PMN) count in ascites,HBP in ascites,and serum PCT level were measured and analyzed.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups;non-normally distributed continuous data were expressed as median [M(P25,P75)],and the Kruskal-Wallis H test was used for comparison between multiple groups and the Nemenyi test was used for comparison between two groups.The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency of HBP in ascites and serum PCT,and the Spearman correlation analysis was used to investigate the correlation between HBP in ascites and serum PCT.Results The cirrhotic ascites + SBP group had significant increases in the levels of HBP in ascites and serum PCT compared with the leaky ascites group,the malignant ascites group,and the tuberculous ascites group(P < 0.05).There was no significant difference in HBP level in ascites between patients with different bacteria determined by bacterial culture of ascites(P > 0.05),and there was also no significant difference in HBP level in ascites between patients with positive or negative results of bacterial culture of ascites(58.59 ± 36.23 ng/ml vs 63.61 ±32.54 ng/ml,t = 1.763,P > 0.05).Serum PCT had an optimal cut-off value of 0.62 ng/ml in the diagnosis of SBP,with an area under the ROC curve of 0.831,a sensitivity of 86.3%,and a specificity of 52.8%.HBP in ascites had an optimal cut-off value of 23.54 ng/ml in the diagnosis of SBP,with an area under the ROC curve of 0.962,a sensitivity of 92.3%,and a specificity of 65.4%.Ascites HBP was highly correlated with serum PCT(r = 0.776,P < 0.05).Conclusion The level of HBP in ascites has a high value in the diagnosis of SBP,and combined measurement of ascites HBP and serum PCT can improve the diagnostic efficiency of SBP.