降钙素原和淀粉样蛋白A在重型肝炎自发性细菌性腹膜炎中的诊断价值  

The values of PCT and amyloid protein A in diagnosing spontaneous bacterial peritonitis in severe hepatitis

作　　者：闫丽娜 原芳[1] YAN Lina;YUAN Fang(Department of Intensive Medicine,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot,Inner Mongolia Autonomous Region 010000,China)

机构地区：[1]内蒙古医科大学附属医院重症医学科,内蒙古自治区呼和浩特010000

出　　处：《安徽医药》2019年第4期771-774,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨降钙素原(procalcitonin, PCT)和淀粉样蛋白A在重型肝炎自发性细菌性腹膜炎(spontaneous bacterial peritonitis, SBP)中的诊断价值。方法自2014年1月至2016年1月,前瞻性收集内蒙古医科大学附属医院收治的重型肝炎124例,根据是否发生SBP分为SBP组(n=48)和非SBP组(n=76),比较两组PCT、淀粉样蛋白A、C反应蛋白、白细胞和白介素6(Interleukin-6, IL-6)水平,并分析PCT、淀粉样蛋白A、C反应蛋白、白细胞和IL-6在诊断重型肝炎病人SBP中的价值。结果与非SBP组比较,SBP组PCT显著升高[(0.78±0.54)比(0.19±0.11)] ng/mL,P=0.000;淀粉样蛋白A显著升高[(23.58±9.58)比(12.57±8.82)]mg/L,P=0.000;C反应蛋白显著升高[(8.68±2.48)比(5.49±1.82)] mg/L,P=0.000;白细胞显著升高[(9.26±3.29)比(7.65±2.84)]×10~9/L,P=0.000;IL-6显著升高[(89.58±38.58)比(39.58±18.58)] pg/mL,P=0.000。PCT、淀粉样蛋白A、C反应蛋白、白细胞和IL-6在诊断重型肝炎SBP中的ROC曲线下面积分别为0.875(95%CI:0.816～0.934)、0.898(95%CI:0.840～0.957)、0.695(95%CI:0.598～0.793)、0.709(95%CI:0.617～0.801)和0.876(95%CI:0.812～0.940),差异有统计学意义(P=0.000)。与存活病人比较,死亡病人入院时PCT显著升高[(1.05±0.51)比(0.70±0.48)] ng/mL,P=0.042。结论 PCT和淀粉样蛋白A在诊断重型肝炎SBP中均具有较强的应用价值,PCT升高可能与SBP预后不良有关。Objective To investigate the values of procalcitonin(PCT)and amyloid protein A in diagnosing spontaneous bacterial peritonitis(SBP)in severe hepatitis.Methods A hundred and twenty-four cases with severe hepatitis admitted to The Affiliated Hospital of Inner Mongolia Medical University from January 2014 to January 2016 were prospectively collected and assigned into two groups according to whether the patients developed SBP or not:SBP group(n=48)and non-SBP group(n=76).The levels of PCT,amyloid protein A,C-reactive protein,white blood cell and interleukin-6(IL-6)of both groups were compared.Moreover,the values of PCT,amyloid protein A,C-reactive protein,white blood cell and IL-6 in diagnosing SBP in patients with severe hepatitis were studied.Results When compared with patients in the non-SBP group,patients in the SBP group got a significantly higher level of PCT[(0.78±0.54)vs.(0.19±0.11)ng/mL,P=0.000],an elevated level of amyloid protein A[(23.58±9.58)vs.(12.57±8.82)mg/L,P=0.000)],a higher level of C-reactive protein[(8.68±2.48)vs.(5.49±1.82)mg/L,P=0.000],a higher level of white blood cell[(9.26±3.29)×10 9/L vs.(7.65±2.84)×10 9/L,P=0.000),and an elevated level of IL-6[(89.58±38.58)vs.(39.58±18.58)pg/mL,P=0.000).The areas of receiver operator characteristic curve of PCT,amyloid protein A,C-reactive protein,white blood cells and IL-6 in diagnosing SBP in patients with severe hepatitis were 0.875(95%CI:0.816-0.934),0.898(95%CI:0.840-0.957),0.695(95%CI:0.598-0.793),0.709(95%CI:0.617-0.801)and 0.876(95%CI:0.812-0.940),respectively,and the differences were statistically significant(P=0.000).When compared with the survivals,patients who died got an elevated level of PCT[(1.05±0.51)vs.(0.70±0.48)ng/mL,P=0.042).Conclusion PCT and amyloid protein A have strong application values in the diagnosis of SBP in patients with severe hepatitis,and an elevated PCT might be related with worse clinical outcomes.

关 键 词：肝炎/并发症 腹膜炎 肝硬化 血清淀粉样蛋白A C反应蛋白质 白细胞介素6 早期诊断 预后 降钙素原 

分 类 号：R512.6[医药卫生—内科学] R572.2[医药卫生—临床医学]