腹水降钙素原诊断肝硬化自发性腹膜炎的临床价值研究  

The Diagnostic Significance of Ascites Procalcitonin in Liver Cirrhosis with Spontaneous Bacterial Peritonitis

作　　者：吴云辉[1] 甘建和[1] 沈佳庆[1] 陆中华[1] 王艳[1] 

机构地区：[1]苏州大学附属第一医院传染科,江苏苏州215006

出　　处：《现代生物医学进展》2015年第30期5875-5877,5938,共4页Progress in Modern Biomedicine

基　　金：国家"十二五"科技重大专项(2012ZX10002004-008)

摘　　要：目的:探讨腹水中降钙素原(PCT)诊断晚期肝硬化腹水并发自发性细菌性腹膜炎(SBP)的临床价值,并确定其参考值水平。方法:选择42例肝硬化失代偿期患者为研究对象(伴SBP22例,非SBP 20例),抽取其住院时、住院后24 h和48 h外周血及腹水标本各一次,进行腹水中有核细胞数计数,并采用免疫荧光层析法同时测定和比较其血清及腹水中PCT的含量。结果:22例伴SBP的患者血清和腹水PCT含量均明显高于20例不伴有SBP的患者(P<0.01),而伴SBP的患者腹水PCT含量和同时间点血清PCT含量比较差异均无统计学意义(P>0.05)。以入院时腹水PCT含量诊断SBP的ROC曲线的AUC为0.986,而血清PCT、腹水PMN计数的AUC分别为0.942、0.868;入院后24时腹水PCT和血清PCT诊断SBP的ROC曲线的AUC分别为0.998和0.986;入院后48时腹水PCT和血清PCT诊断SBP的ROC曲线的AUC为0.986和0.990。结论:腹水降钙素原可用于晚期肝硬化腹水并发SBP的诊断,且较血清降钙素原和腹水中有核细胞计数具有更高的诊断价值。入院时、入院后24 h和48 h时,腹水PCT大于0.565 ng/m L、0.545 ng/m L和0.410 ng/m L提示患SBP可能性大。Objective： To discuss the clinical value of ascites procalcitonin（PCT） in the diagnosis of decompensated cirrhosis combined with spontaneous bacterial peritonitis（SBP）, and determine the reference level of ascites PCT. Methods： 42 patients with liver cirrhosis combined with ascites were enrolled in this study and divided into two groups. In group 1, 22 patients with SBP were enrolled.20 without SBP were enrolled in group 2, and ascite sample were collected at admission, 24 hrs, and 48 hrs after admission. Serum and ascites PCT were measurated by immunochromatographic assay simultaneously, then comparative analysis the level of their changes.Results： The serum and ascite levels of PCT in patients（n=22） with SBP were significantly higher than those without SBP（n = 20）（P〈0.01）; but there is no statistical significance between the ascites and serum level of PCT in patients with SBP（P〈0.05）. A more sensitive diagnostic role of ascites PCT levels was found compared with serum PCT and ascites cell counts. The AUCs of ROC curve were： at admission： ascites PCT 0.986, serum PCT 0.942 and ascites cell counts 0.868; 24 h after admission： ascites PCT 0.998 and serum PCT0.986; 48 h after admission： ascites PCT 0.986 and serum PCT 0.990. Conclusion： Serum ascites PCT could be used in the diagnosis in liver cirrhosis with SBP, and may be more sensitive than serum PCT and ascites cell counts. The SBP could be diagnosed, if the ascites PCT levels was higher than 0.565 ng/m L（on admission）, 0.545 ng/m L（24 h after admission） and 0.410 ng/m L（48 h after admission）.

关 键 词：自发性细菌性腹膜炎 腹水降钙素原 肝硬化失代偿期 

分 类 号：R575.2[医药卫生—消化系统]