血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析

doi:10.3969/j.issn.1672-5069.2020.05.024

摘要/Abstract

摘要： 目的评估血清C-反应蛋白(CRP)和降钙素原(PCT)预测失代偿期肝硬化患者发生自发性细菌性腹膜炎(SBP)的临床价值。方法 2014年12月～2018年6月我院住院的失代偿期肝硬化患者148例,检测血清CRP和PCT及腹水多形核细胞(PMN)计数,采用二分类Logistic回归分析和受试者工作特性曲线(ROC)下面积(AUC)分析指标诊断SBP的效能。结果在148例失代偿期肝硬化患者中,诊断SBP 90例,非感染性腹水患者58例;SBP患者Child-Pugh评分为(11.5±1.4),显著高于肝硬化患者,腹水PMN计数为 280.0(61.5,582.0)×10⁶/L,显著高于肝硬化患者,外周血WBC计数为(7.5±3.2)×10⁹/L,显著高于肝硬化患者,血清PCT为[3.91(1.32,9.61)ng/ml,显著高于肝硬化患者, 血清CRP为(32.0±21.7)mg/L,显著高于肝硬化患者; Logistic回归分析结果显示腹水PMN计数、血清PCT和CRP水平是失代偿期肝硬化患者发生SBP的独立危险因素(P均<0.05);腹水PMN计数、血清PCT和CRP诊断SBP敏感性分别为75.6%、73.3%和72.2%,特异性分别为68.9%、75.6%和88.9%,而以血清PCT=0.45ng/ml和CRP=12.68 mg/L为同时必须达到的标准,结果联合检测诊断SBP的敏感性为66.7%,特异性为90.0%。结论检测腹水PMN计数及血清PCT和CRP水平有助于早期诊断失代偿期肝硬化患者并发SBP,对早期治疗有很大的益处。

关键词: 肝硬化, 自发性细菌性腹膜炎, C-反应蛋白, 降钙素原, 受试者工作特性曲线 , ,

Abstract: Objective The aim of this study was to evaluate the clinical value of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in predicting spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis. Methods A total of 148 patients with decompensated liver cirrhosis were included in our hospital between December 2014 and June 2018. Polymorphonuclear cells (PMN) in ascites, and serum CRP and PCT levels were detected routinely, binary Logistic regression analysis was applied to evaluate the risk factors of SBP occurrence and the diagnostic efficacy of clinical data in diagnosing SBP was analyzed by using the area under the receiver operating characteristic curve (AUROC). Results There were 90 patients diagnosed as having SBP and 58 had non-infected ascites; the Child-Pugh score in patients with SBP was (11.5±1.4), significantly higher than in patients without SBP, the PMN counts in ascites was 280.0 (61.5,582.0)×10⁶/L, significantly higher than , peripheral blood WBC count was [(7.5±3.2)×10⁹/L, much higher than [(3.8±1.7)×10⁹/L, P<0.05), serum PCT level was 3.91(1.32,9.61)ng/ml, significantly higher than and serum CRP level was (32.0±21.7) mg/L, much higher in patients without SBP; the results of Logistic regression analysis showed that PMN counts, serum PCT and CRP levels were the independent risk factors for SBP occurrence in patients with decompensated liver cirrhosis (P<0.05); the sensitivities (Se) of PMN counts in ascites, serum PCT and CRP levels in diagnosing SBP were 75.6%, 73.3% and 72.2%,and the specificities (Sp) were 68.9%, 75.6% and 88.9%, while when serum PCT equal to 0.45 ng/ml and serum CRP equal to 12.68 mg/L as the combination cut-off-value, the Se and Sp were 66.7% and 90.0%, respectively. Conclusion The measurement of PMN counts in ascites and serum PCT and CRP is helpful in diagnosing SBP in patients with decompensated liver cirrhosis in time, which might guide management of patients in this settings.

Key words: Liver cirrhosis, Spontaneous bacterial peritonitis, C-reactive protein, Procalcitonin, Receiver operating characteristic curve

扈登财, 杜莉, 曹成红, 史晋洁, 李亚宁. 血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析[J]. 实用肝脏病杂志, 2020, 23(5): 699-702.

Hu Dengcai, Du Li, Cao Chenhong, et al.. Serum procalcitonin and C-reactive protein levels in predicting spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(5): 699-702.

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