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

目的 探讨血降钙素原(procalcitonin, PCT)和中性粒细胞比例(percentage of neutrophils, Neu%)对肝病自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)的诊断价值.方法 回顾性分析2014年1月至2016年12月在西南医院感染科住院且入院后同时检测PCT、血常规、腹水常规和腹水培养的130例肝病腹水患者临床资料,SBP确诊组89例,其中培养阳性且多形核细胞(polyremorphonuclear,PMN)≥250×106/L 患者10例(SBP1组),培养阳性但PMN<250×106/L 患者11例(SBP2组),培养阴性但PMN≥250×106/L 患者68例(SBP3组);非感染性腹水组41例.比较4组患者入院时的血PCT、Neu%、腹水PMN等指标.通过受试者工作曲线(ROC)评价PCT、Neu%对SBP的诊断价值及效能.结果 PMN≥250×106/L 的SBP患者培养阳性率为12.8%.PCT在培养阳性的腹水患者中显著高于培养阴性的患者中位数(四分位距)]:4.51(1.54,8.46)vs 0.77(0.21,1.69),P<0.05].通过ROC曲线分析,PCT诊断SBP1、SBP2、SBP3的最佳界值分别为:0.795、0.265、0.405 ng/mL;AUC值依次为:0.963、0.767、0.714;敏感度依次为:100.00%、90.00%、62.30%;特异度依次为:92.70%、63.40%、80.50%;血常规Neu%诊断的最佳界值分别为:68.45%、62.65%、65.00%;AUC值依次为:0.878、0.756、0.669.依据上述界值,降钙素原和中性粒细胞比例两者串联诊断SBP1、SBP2、SBP3的AUC值依次为:0.976、0.865、0.706.结论 血降钙素原和血常规中性粒细胞比例在SBP中均具有一定的预警效果和诊断价值,不同类型SBP其CUT-OFF值不同,临床可根据实际情况综合分析.

Diagnostic value of serum procalcitonin level and neutrophil percentage in prediction of spontaneous bacterial peritonitis in patients with liver disease

Objective To investigate the diagnostic value of serum procalcitonin(PCT) and percentage of neutrophils(Neu%) in the prediction of spontaneous bacterial peritonitis(SBP) in liver disease.Methods A retrospective analysis was conducted on 130 ascites patients hospitalized in the Southwest Hospital from January 2014 to December 2016.Clinical data of their serum PCT assay, common laboratory test and culture of ascites were collected.There were 89 patients verified with SBP, including 10 cases(SBP1 group) with culture-positive and polymorphonuclear(PMN) cells ≥250×106/L, 11(SBP2 group) with culture-positive and PMN cells <250×106/L, and 68(SBP3 group) with culture-negative but PMN ≥250×106/L.The other 41 patients were assigned as non-infective ascites group.The PCT level, Neu% and ascites PMN count were compared among the 4 groups.Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic performance of PCT level and Neu% for SBP.Results Culture positivity was determined in 12.8% of SBP patients with PMN≥250×106/L.Serum PCT levels was significantly higher in the patients with positive bacterial culture in ascitic fluid compared to patients with negative culture median(min-max): 4.51(1.54, 8.46) vs 0.77(0.21, 1.69), P<0.05].ROC analysis showed that the optimal cut-off values of PCT were 0.795, 0.265 and 0.405 ng/mL, respectively in the diagnosis of SBP1, SBP2 and SPB3, with areas under curves(AUC) of 0.963, 0.767 and 0.714, separately, sensitivities of 100.00%, 90.00% and 62.30%, respectively, and specificities of 92.70%, 63.40% and 80.50%.The optimal cut-off values of Neu% in the diagnosis of SBP1, SBP2 and SPB3 were 68.45%, 62.65% and 65.00%, respectively, with AUC of 0.878, 0.756 and 0.669, respectively.According to the cut-off value above, PCT and Neu% in the diagnosis of SBP1, SBP2 and SPB3, the AUC were 0.976, 0.865 and 0.706, respectively.Conclusion Serum PCT level and Neu% are of early warning effect and diagnostic value for SBP.Different SBP types have different cut-off values.Comprehensive analysis can be carried out on the actual situation in clinical practice.