腹水钙卫蛋白含量对肝硬化自发性细菌性腹膜炎的诊断评价

Value of calprotectin content in ascites in diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis

目的探讨肝硬化腹水中钙卫蛋白水平对自发性细菌性腹膜炎（SBP）的诊断价值。方法从108例肝硬化腹水患者获得136份腹水标本,分成试验组（SBP）41份和对照组（非SBP）95份,检测腹水中钙卫蛋白含量,同时两组均收集临床资料及腹水相关检测结果,比较使用抗菌药物前试验组和对照组腹水钙卫蛋白含量水平,以及试验组使用抗菌药物前后腹水钙卫蛋白含量变化,绘制ROC曲线,确定腹水钙卫蛋白诊断SBP的临界值。结果治疗前试验组钙卫蛋白含量270-15 273ng/ml,显著高于对照组0-75ng/ml（P〈0.001）,试验组治疗后钙卫蛋白含量9-13 043ng/ml,显著低于治疗前,差异有统计学意义（P〈0.01）,钙卫蛋白与中性粒细胞（PMN）呈相关性（r=0.76039,P〈0.0001）;以687ng/ml作为诊断的临界值,此时钙卫蛋白诊断SBP的敏感性90.7%、特异性为86.3%。结论腹水中钙卫蛋白水平可以作为诊断SBP的特异性和敏感性较好的指标,值得临床推广。

OBJECTIVE To explore the clinical value of the calprotectin level in ascites in diagnosis of spontaneous bacterial peritonitis（SBP）.METHODS A total of 136 ascites specimens were collected from 108 patients with liver cirrhosis and divided into the experimental group with 41specimens（SBP）and the control group with 95specimens（non-SBP）.The calprotectin level in ascites were determined,meanwhile,the clinical data were collected from the two groups of patients,and the results of detection of ascites were analyzed;the calprotectin level in the ascites was compared between the experimental group and the control group before the use of antibiotics,the change of the calprotectin level in ascites of the experimental group was observed before and after the use of antibiotics,the ROC curve was drawn to determine the critical value of the ascites calprotectin in diagnosis of SBP.RESULTS The calprotectin level of the experimental group was 270-15 273ng/ml before the treatment,significantly higher than 0-75ng/ml of the control group（P〈0.001）.The calprotectin level of the experimental group was 9-13 043ng/ml after the treatment,significantly lower than that before the treatment,with significant difference（P〈0.001）.The calprotectin level showed association with neutrophils（r=0.76039,P〈0.0001）.Set687ng/ml as the critical value,the sensitivity of the calprotectin in diagnosis of SBP was 90.7%,the specificity86.3%.CONCLUSIONThe calprotectin level in ascites can be used as an indicator for diagnosis of SBP,with the sensitivity and specificity high,and it is worthy to be promoted in the hospital.