人中性粒细胞防御素对自发性细菌性腹膜炎的诊断价值  

Diagnostic value of human neutrophil peptide in spontaneom bacterial peritonitis

作　　者：公彦雪[1] 崔速南[2] 李莉[3] 汪明明[2] 郭楠[1] 

机构地区：[1]山东大学医学院,济南250012 [2]山东大学附属济南市传染病医院肝病科 [3]山东大学附属济南市传染病医院检验科

出　　处：《中华肝脏病杂志》2013年第12期944-948,共5页Chinese Journal of Hepatology

摘　　要：目的探讨人中性粒细胞防御素（HNP）与自发性细菌性腹膜炎（SBP）的相关性及其对SBP的诊断价值。方法77例肝硬化并腹水患者按有无SBP分组：SBP组45例，非SBP组32例，设立健康体检者对照组28名。采用双抗体夹心法检测血浆HNP。同时检测外周血白细胞总数、中性粒细胞比率、降钙素原（PeT）和C-反应蛋白（CRP）等炎性指标。做受试者工作曲线比较HNP、PCT和CRP在SBP中的诊断价值。计量资料采用单因素方差分析和q检验，计数资料采用χ2检验，多个实验组间的两两比较采用χ2分割法；受试者工作曲线下面积采用z检验。结果外周血白细胞总数在SBP组为（6．01±2．25）×10^9／L、非SBP组为（4．85±1．94）×10^9／L、对照组为（5．49±1．76）×10^9／L，差异无统计学意义（F=2．91，P〉0．05）；中性粒细胞比率分别为70．7％±10．4%、68．2％±9．0%、69．5％±8．7％，差异无统计学意义（F=3．07，P〉0．05）。3组血浆HNP值差异有统计学意义（F=4．05，P〈0．05），且SBP组[（17．66±6．40）ng／ml]明显高于非SBP组[（9．99±3．33）ng／ml]与对照组[（8．92±2．30）ng／ml]，q值分别为3．20，3．52，P值均〈0．05。3组CRP值差异有统计学意义（F=33．02，P〈0．05），且SBP组[（31．32±18．65）mg／L]及非SBP组[（15．08±9．95）mg／L]与对照组[（5．96±2．91）mg／L]比较，q值分别为11．03和3．69，P值均〈0．05。PCT阳性率在SBP组为62．2％，与非SBP组25．0％和对照组10．7％比较，x2值分别为10．41，15．40，P值均〈0．05。HNP的曲线下面积最高，PeT次之，CRP最低，分别为0．719，0．707，0．629。当HNP、PeT和CRP的截断值分别为10ng／ml、0．5ng／ml和8mg／L时，其对SBP诊断的敏感度分别为71．1％、62．2％和73．3％，特异度分别为71．9％、75．0%和56．3％，Youden指数分别为0．430、0．372和0．296。结论HNP与SBP明�Objective To investigate the correlation between human neutrophil peptide （HNP） and spontaneous bacterial peritonitis （SBP） in order to assess the diagnostic value of quantitative measurement of these alpha-defensins. Methods Seventy-seven patients with cirrhosis and ascites were divided into two groups according to diagnosis of SBP （n = 45 with SBP and n = 32 without SBP）. Twenty-eight healthy individuals were analyzed as controls. HNP was detected by double- antibody sandwich assay. Peripheral white blood cell （WBC） counts, neutrophil ratio, and levels of procalcitonin （PCT） and C-reactive protein （CRP） were determined by standard methods. Receiver operating characteristic （ROC） curves were used to compare the diagnostic values of HNP, PCT andCRP in SBP. Results There were no significant differences between the three groups （SBP, non-SBP, and healthy controls） for WBC count （（6.01 ± 2.25） ×10^9/L, （4.85 ± 1.94） ×10^9/L, and （5.49 ±1.76）× 10^9/L;F= 2.91, P 〉 0.05） and neutrephil ratio （70.70%± 10.42%, （68.20% ± 8.97%, and 69.50% ± 8.69%; F = 3.07, P 〉 0.05）. However, compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher levels of HNP （（9.99 ± 3.33） ng/ml and （8.92± 2.30） ng/ml vs. （17.66± 6.40） ng/ml; q = 3.20 vs. 3.52, P 〈 0.05）, serum CRP （（15.08 ± 9.95） ng/ml and （5.96 ± 2.91） ng/ml vs. （31.32± 18.65） mg/L; q = 11.03 vs. 3.69, P 〈 0.05）, and positive rate of PCT （25.0% and 10.0% vs. 62.2%;χ2 = 10.41 vs. 15.40, P 〈 0.0125）. The areas under the curve （AUC） showed the following descending trend： HNP 〉 PCT 〉 CRP （0.719, 0.707, and 0.629 respectively）. Using cut-offpoints of 10 ng/ml for HNP, 0.5 ng/ml for PCT, and 8 mg/L for CRP, the respective sensitivities for diagnosis of SBP were 71.1%, 62.2%, and 73.3%, the respective specificpeties were 71.9%, 75.0%, and 56.3%, and the respective Youden＇s indexes were 0.430, 0.372, and 0.296. Conclusi

关 键 词：腹膜炎 诊断 人中性粒细胞防御素 降钙素原 C反应蛋白 

分 类 号：R572.2[医药卫生—消化系统]