四种急性时相蛋白对肝硬化继发感染的早期诊断价值的探讨

The value of serum acute phase proteins in early diagnosis of hepatic cirrhosis complicated with infection

目的 :探讨各种急性时相蛋白 (APP)对肝硬化继发感染早期诊断的临床价值及各项 APP对感染预测的参考值。方法 :采用全自动速率散射比浊法对 5 1例肝硬化患者进行 4种 APP〔C反应蛋白 (CRP)、α1 酸性糖蛋白 (AAG)、铜蓝蛋白 (CER)和触珠蛋白 (HPT)〕的动态检测 ,2 5例肝硬化继发感染者中 14例于感染控制后再行监测 ,并与非肝硬化感染组、非肝硬化无感染组进行对比分析。结果 :肝硬化继发感染患者入院第 2日CRP、AAG、HPT显著高于无继发感染组 ,以正常人群的 APP水平上限为标准 (即 8mg/ L ) ,则 CRP对感染诊断的敏感度及特异度分别为 88.0 0 %和 76 .92 % ;如 CRP以肝硬化无感染组的 95 %正常值为参比值上限 (即16 mg/ L) ,则特异度为 92 .31% ;其它 3项 APP的敏感度较低 ,但特异度高 ;如 CRP和 AAG两项指标结合判断 (即同时 CRP≥ 8mg/ L ,AAG≥ 12 5 0 mg/ L为参比值 ) ,本资料中感染特异度判断达 10 0 %。 CRP以 8mg/ L为参考值上限 ,外周血白细胞计数高于 10× 10 9/ L 为异常 ,则 CRP与外周血白细胞计数相比 ,入院第 2日肝硬化并感染患者的异常率分别为 88.0 0 %和 31.82 %。对 14例感染控制前后患者的 APP动态监测发现 ,CRP呈显著负相关 ,而其它 3项指标差异不显著。结论 :CRP,AAG和 HPT对诊断肝?

Objective:To investigate the value of serum acute phase proteins in early diagnosis of hepatic cirrhosis complicated with infection.Methods:Fiftyone patients with hepatic cirrhosis,of whom 25 complicated with infection,were studied.Serum levels of Creactive protein (CRP),α 1acid glycoprotein(AAG),haptoglobin(HPT) and ceruloplasmin (CER) were measured on the second day of admission.All parameters were measured again in 14 patients with hepatic cirrhosis complicated with infection when the infection was under control.Results:Compared with control group,CRP,AAG,HPT were significantly higher in infection group.CRP was significantly decreased after infection was under control,but no significant changes was noted in AAG,HPT,CER.Our study showed that CRP had a sensitivity of 88 00% and specificity of 76 92% in predicting infection if highest range of normal CRP was set to 8 mg/L.Taking account of the higher CRP in hepatic cirrhosis than in those of nonhepatic cirrhosis group,if the highest range of normal CRP was set to 16 mg/L ,which was the mean level in cirrhosis group without infection,the specificity was 92 31%. Conclusions: CRP,AAG and HPT are useful in early diagnosis of hepatic cirrhosis complicated with infection and CRP is more valuable.CRP is also useful in predicting the therapeutic effects.The level of significance of CRP should be set to >16 mg/L to insure the specificity of diagnosis.