快速诊断肝硬化自发性细菌性腹膜炎的方法研究  

Study on the method of rapid diagnosis of liver cirrhosis spontaneous bacterial peritonitis

作　　者：徐斐[1] 刘菲[1] 

机构地区：[1]同济大学附属东方医院消化内科,上海200085

出　　处：《国际消化病杂志》2015年第6期413-416,共4页International Journal of Digestive Diseases

摘　　要：目的通过对腹水总有核细胞计数、白细胞酯酶浸试条、乳铁蛋白诊断自发性细菌性腹膜炎(SBP)价值的比较,评价乳铁蛋白在快速诊断肝硬化SBP中的意义。方法以145例确诊为肝硬化腹水的患者为研究对象,收集腹水标本后分别进行中性粒细胞(PMN)计数、总有核细胞计数、白细胞酯酶浸试条检测、乳铁蛋白定量分析,以腹水PMN计数为诊断SBP金标准。以受试者工作特征(ROC)曲线确定最佳诊断阈值,分别计算腹水总有核细胞计数、白细胞酯酶检测浸试条、腹水乳铁蛋白定量诊断SBP的合理诊断阈值及诊断敏感度和特异度、阳性预测值及阴性预测值。根据ROC曲线下面积来评估在诊断肝硬化SBP上更具优势的指标。结果以腹水PMN计数>0.25×109/L为即刻诊断SBP的金标准,腹水乳铁蛋白定量诊断肝硬化SBP的ROC曲线下面积为0.992,较腹水总有核细胞计数和白细胞酯酶检测浸试条更具诊断价值;以腹水乳铁蛋白定量>312 ng/m L作为最佳诊断阈值,具有较高的诊断敏感度和特异度。结论腹水乳铁蛋白定量检查可快速准确地诊断肝硬化SBP,对早期诊断、早期治疗SBP具有较好的指导价值。Objective Through comparing the value of total nuclear cell count,leukocyte esterase leaching test and lactoferrin in diagnosis of spontaneous bacterial peritonitis(SBP),we can evaluate the significance of lactoferrin in the rapid diagnosis of liver cirrhosis SBP.Methods The study was based on 145 patients with ascites due to liver cirrhosis.We collected samples of ascites to do the polymorphonuclear(PMN) cell count,total nuclear cell count,leukocyte esterase leaching test and lactoferrin quantitative analysis.PMN count in the ascites was the gold standard for diagnosis of SBP.We made the receiver operating characteristic(ROC)curve to determine the optimal diagnostic threshold.We calculated the reasonable diagnosis threshold,diagnostic sensitivity,specificity,positive predictive value and negative predictive value of the total nuclear cell count,leukocyte esterase leaching test and lactoferrin quantitative analysis.We can evaluate more dominant indicator in the diagnosis of liver cirrhosis SBP according to the area under the ROC curve.Results PMN in the ascites > 0.25 × 109/ L as the gold standard for immediate diagnosis of SBP,through ascitic lactoferrin quantitative analysis in diagnosis of liver cirrhosis SBP,the area under the ROC curve was 0.992.Lactoferrin quantitative analysis had more diagnostic value than total nuclear cell count and leukocyte esterase leaching test.We regard ascitic lactoferrin quantitative > 312 ng / m L as the best diagnostic threshold because it has higher diagnostic sensitivity and specificity than other indexes.Conclusion We can make rapid and accurate diagnosis of SBP according to ascitic lactoferrin quantitative analysis.Lactoferrin has guidance value in early diagnosis and treatment of SBP.

关 键 词：自发性细菌性腹膜炎 诊断 乳铁蛋白 白细胞酯酶浸试条 腹水总有核细胞计数 

分 类 号：R575.2[医药卫生—消化系统] R572.2[医药卫生—内科学]