血清PCT检测在肝硬化合并自发性细菌性腹膜炎分级诊疗中的应用价值  

Application value of grading therapy of PCT in patients with cirrhosis and spontaneous bacterial peritonitis

作　　者：张燕[1] 王全楚[1] 李娜[1] 

机构地区：[1]解放军第153中心医院感染科,河南郑州450042

出　　处：《胃肠病学和肝病学杂志》2016年第6期663-665,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨依据血清降钙素原（procalcitonin,PCT）水平对肝硬化合并自发性细菌性腹膜炎（spontaneous bacterial peritonitis,SBP）患者进行分级诊疗的可能性。方法选取解放军第153中心医院2013年2月-2016年2月收治的430例肝硬化腹水合并SBP患者作为观察对象,入院次日使用抗生素前应用电化学发光免疫法（ECLI）测定全部患者外周血PCT水平;然后依据PCT由低到高的4个层级水平（0.1~0.5 ng/ml、0.5~2.0 ng/ml、2.0~10 ng/ml、〉10 ng/ml）将肝硬化合并SBP患者按病情严重程度相应地分成轻度、中度、重度、极重度4个组别,分别进行规范化的抗感染和护肝治疗,1个月后观察疗效并判断预后。结果 430例SBP患者分为A级轻度310例（72.1%）,B级中度73例（17.0%）,C级重度28例（6.5%）,D级极重度19例（4.4%）。随PCT水平由A、B、C、D逐级升高,SBP病情由轻度、中度、重度、极重度逐步加重,并发症明显增多,病死率显著增加的趋势相当明显。B组、C组、D组的病死率较A组明显增加,差异有统计学意义（P〈0.01）。结论血清PCT水平检测对肝硬化合并SBP的早期诊断并据此进行分级诊疗有一定的临床价值。Objective To detect the concentration of procalcitonin （PCT） in blood and to investigate the diagnosis value of PCT in patients with cirrhosis and spontaneous bacterial peritonitis （SBP）. Methods Four hundred and thirty patients with cirrhosis and SBP were divided into 4 groups according to PCT different levels A to D. The PCT in blood was determined by electrochemiluminescence immunoassay （ECLI）. The fasting venous blood in the upper limb were obtained from all patients at the time of within 24 hours after admission, before using of antibiotics. Results The con- centration of PCT in 430 patients with SBP as follows： there were 310 cases （72.1%） in group A, 73 cases （17.0%） in group B, 28 cases （6.5%） in group C and 19 cases （4.4%） in group D. The concentration of PCT in group B - D with severer SBP and poorer outcome was higher than that in group A, which had statistical differences （P 〈 0.01 ）. Conclusion The detection of the concentration of PCT in blood has certain clinical significance in diagnosis and grading therapy in patients with cirrhosis and SBP.

关 键 词：肝硬化 降钙素原 分级诊疗 自发性细菌性腹膜炎 

分 类 号：R575.2[医药卫生—消化系统]