血清及腹水脂多糖结合蛋白检测在肝硬化自发性细菌性腹膜炎诊断中的意义

Significance of lipopolysaccharide binding protein in serum and ascites of patients with hepatic cirrhosis complicated with spontaneous bacterial peritonitis

目的检测肝硬化患者血清及腹水中脂多糖结合蛋白（LBP）的水平，探讨血清及腹水LBP检测对自发性细菌洼腹膜炎（SBP）的诊断价值。方法将肝硬化患者分为肝硬化SBP组、腹水非SBP组、肝硬化无腹水组3组，同时将腹水非SBP组分别以有无腹痛、血白细胞计数（WBC）增高、腹痛＋血WBC升高为标准分为2组，探讨LBP对临床疑诊SBP的意义。并加设阳性和阴性对照组（腹腔脓液组、健康对照组）。以酶联免疫吸附法测定各组血清及腹水LBP水平；肝硬化腹水患者同时完成腹水常规、腹水培养、腹水白蛋白等检查。组间数据比较采用t检验或独立样本的非参数检验，曲线下面积（AUC）比较采用Z检验。结果腹腔脓液组血清及脓液LBP水平较肝硬化腹水组血清及腹水LBP水平明显增高，对比组之间的差异具有统计学意义（P〈0．01）。肝硬化SBP组血清LBP水平较，腹水非SBP组及无腹水组血清LBP水平明显增高，对比组之间的差异具有统计学意义（P〈0．01）;肝硬化SBP组腹水LBP水平较腹水非SBP组腹水LBP水平差异无统计学意义（P〉0．05）。临床疑诊的肝硬化SBP组血清及腹水LBP水平较肝硬化腹水非SBP组血清及腹水LBP水平明显增高，对比组之间的差异具有统计学意义（中位数分别为228．00ug／ml对比80．95μg／ml及22．50μg／ml对比11．45μg／ml，P〈0．05）。血清LBP测定较腹水LBP测定及腹水WBC具有更高的敏感性。结论腹腔内革兰阴性菌感染可使患者血清及体液LBP水平明显升高。肝硬化SBP患者血清LBP水平明显增高。临床疑诊SBP的肝硬化患者血清及腹水LBP明显升高，血清LBP结合腹水LBP检测能提示腹腔内感染存在，对SBP有一定的诊断价值。

Objective To investigate the levels of lipopolysaccharide binding protein （LBP） in serum and ascites of cirrhotic patients, and determine their diagnostic value for spontaneous bacterial peritonitis （SBP）. Methods Cirrhotic patients were divided into groups according to diagnosis of SBP, ascites without SBP, no ascites. To explore the significance of LBP in clinically suspect SBP cases, the ascites without SBP group was sub-divided into two groups according to the symptoms of abdominal pain or elevated white blood cell （WBC） count, and abdominal pain combined with elevated WBC count. Two control groups were composed of patients with intraperitoneal pus and a group of healthy, non-cirrhotic individuals. The LBP levels in serum and ascites were determined by enzyme-linked immunosorbent assay （ELISA）. The ascites routine, ascites culture and albumin assay were carried out in the Second Affiliated Hospital of Chongqing Medical University. Data between the two groups were compared using the t-test or nonparametric test of independent samples, and the areas under the curve were compared using the Z test. Results The levels of LBP in serum and pus were significantly higher in the intraperitoneal pus group than in the cirrhosis group with ascites （P〈0.01）. The level of serum LBP was significantly higher in the cirrhosis group with SBP than in the cirrhosis group without SBP but with ascites and the cirrhosis group with no ascites （P〈0.01）. There was no significant difference in the level of ascites LBP in the cirrhosis group with SBP and the cirrhosis group without SBP but with ascites （P〉0.05）. In the clinically suspect cases with SBP, the levels of LBP in serum and ascites were significantly higher than those in the cirrhosis group without SBP but with ascites （228.00 μg/ml vs. 80.95 μg/ml and 22.50μg/ml vs. 11.45 μg/ml, P〈 0.05）. Determination of serum LBP had a higher sensitivity than the determination of ascites LBP or ascites WBC. Conclusion Gram-negative bacteria infection in the intra-abdominal cavity causes serum and body fluid levels of LBP to increase significantly. Patients with cirrhosis complicated with SBP have significantly elevated levels of serum LBP. The serum and ascites LBP levels are significantly elevated in SBP patients with suspected clinical diagnosis. Measurements of both the serum LBP and ascites LBP may have diagnostic value for SBP.