血清降钙素原和内毒素在肝硬化患者腹水感染中的诊断价值

The values of serum procalcitonin and endotoxin in diagnosis of the ascitic infection in patients with cirrhosis

目的探讨血清降钙素原和内毒素浓度在肝硬化患者腹水感染诊断中的应用价值。方法回顾性研究首都医科大学附属北京佑安医院2012年8月至2013年12月的61例肝硬化腹水感染患者和67例肝硬化腹水无感染患者的血清降钙素原和内毒素的质量浓度并进行统计分析。结果腹水培养阳性的病原菌最常见的依次为屎肠球菌、溶血葡萄球菌、大肠埃希菌、表皮葡萄球菌等。与非腹水感染组相比,腹水感染组的血清降钙素原、内毒素检测结果均显著升高,差异具有统计学意义(P<0.01);降钙素原和内毒素ROC的曲线下面积分别为0.983和0.919;同时,在诊断腹水感染时,降钙素原的敏感度为93.4%,特异度为88.1%;内毒素的敏感度为83.6%,特异度为97.0%。结论血清降钙素原和内毒素质量浓度在肝硬化腹水感染患者中均升高,且具有很高的敏感度和特异度,可作为诊断腹水感染快速而准确的辅助指标并应用于临床,尤其是降钙素原的临床诊断应用价值更高些。

Objective To investigate the clinical value of serum procalcitonin and endotoxin in diagnosis of the ascitic infection in patients with liver cirrhosis .Methods Retrospective study on 61 cirrhotic patients with ascitic infection and 67 cirrhotic patients with sterile ascites in Beijing Youan Hospital from August 2012 to December 2013 .The levels of procalcitonin and endotoxin in serum of these patients were analyzed .Results The common pathogens were Enterococcus faecium, Staphylococcus haemolyticus, Escherichia coli, Staphylococcus epidermidis and so on.Mean values of procalcitonin and endotoxin in the ascitic infection group were significantly higher than those in the non-ascitic infection group（P〈0.01）.ROC curve analysis showed that the areas under the curve of procalcitonin and endotoxin were 0.983 and 0.919, respectively.The sensitivities of procalcitonin and endotoxin were 93.5% and 83.6% respectively, while the specificities were 88.1% and 97.0% respectively in diagnosis of the ascitic infection .Conclusion The serum levels of procalcitonin and endotoxin in cirrhotic patients with ascitic infection both rose and had high sensitivities and specificities .Detections of procalcitonin and endotoxin could be applied in diagnosis of ascitic infection in patients with cirrhosis as fast and accurate auxiliary indicators.The value of procalcitonin was higher especially .