血清降钙素原对肝硬化败血症的诊断价值

Study on the value of serum procalcitonin in the diagnosis of cirrhosis with sepsis

目的探讨血清降钙素原（PCT）对肝硬化败血症的诊断价值。方法选择113例肝硬化败血症的患者（败血症组）,48例肝脏肿瘤高热患者（肿瘤组）及50例健康体检者,分别检测血清PCT水平。同时对肝硬化败血症患者PCT与血培养结果进行比较,并重复检测肝硬化败血症患者高热开始及高热后24、48、72 h的PCT水平,比较细菌、真菌感染患者血清PCT水平及治疗变化。结果感染开始时,败血症组PCT阳性率为82.3%,显著高于肿瘤组16.7%和健康对照组0,差异有统计学意义（P〈0.05）;血清PCT诊断肝硬化感染革兰阴性细菌的灵敏度、特异度分别为86.7%;84.8%,革兰阳性细菌的灵敏度、特异度分别为87.5%、84.6%,真菌的灵敏度、特异度分别为83.3%、86.7%,PCT的检测结果回报时间约2 h,明显短于细菌培养和鉴定时间48~72 h。随着治疗时间的延长,PCT水平在细菌阳性组明显下降,而真菌阳性组无明显变化。结论血清PCT诊断肝硬化感染具有准确、特异、快速的优点,有利于指导临床早期应用抗生素,改善患者预后。

Objective To explore the diagnostic value of serum procalcitonin（PCT）for cirrhosis with sepsis. Methods According to the clinical symptoms of infection,113 cirrhosis patients suffering from sepsis（sepsis group）,48 patients with liver tumor fever（tumor group）and 50 healthy volunteers（control group）were recruited,and serum PCT level was tested.PCT levels and blood culture results were compared in cirrhosis patients with septicemia.PCT levels were detected in these patients at onset and 24h,48h,72h after high fever,respectively.Serum PCT levels were analyzed between patients suffered from bacteria and fungus after treatment.Results In the early stages of infection, PCT positive rate of sepsis group was 83.3%,significantly higher than that of tumor group（16.7%）and control group（0%,P0.05）.Sensitivity and specificity of serum PCT were 86.7% and 84.8%in gram-negative bacteria infection, 87.5%and 84.6%in gram-positive bacteria infection,and 82.3%and 86.7%in fungal infection.The time of diagnosis is shorter in PCT detection（about 2 h）than that of bacteria culture and identification（about 48-72 h）.With the prolonger of treatment time,the PCT level was significantly decreased in patients with bacterial infection than that in patients with fungal infection.Conclusion Serum PCT diagnosis of infection has the advantages in accuracy,specificity and rapidity. It is helpful for physicians applying antibiotics treatment earlier according to serum PCT level,and for improving the outcomes of cirrhosis patients with sepsis.