降钙素原、超敏C反应蛋白、中性粒细胞比率对肝衰竭并发自发性腹膜炎的临床诊断价值探讨

Clinical evaluation and application of procalcitonin,hs-C-reactive protein,neutrophils ratio in liver failure complicated with SBP

目的研究血液中降钙素原（PCT）、超敏C反应蛋白（hs-CRP）以及中性粒细胞比率（NE%）检测在肝衰竭并发自发性腹膜炎（SBP）的应用价值,从而有效判断及控制肝衰竭病情进展,改善肝衰竭预后。方法选取新疆医科大学第一附属医院2013年9月至2015年7月收治的肝衰竭患者共85例,以有无并发SBP分为观察组（49例）和对照组（36例）;检测所有患者入院24 h内的PCT、hs-CRP及NE%,对比两组患者血清中PCT、hs-CRP和NE%的水平,并对其结果采用SPSS 17.0进行统计分析。结果肝衰竭伴SBP的发生在性别、年龄的构成比之间均无差异（P〉0.05）;与非SBP组相比,SBP组血PCT、hs-CRP均明显升高（P均〈0.05）,NE%亦升高（P〉0.05）;PCT的ROC曲线下面积为0.871（95%CI 0.789~0.953）,hs-CRP的ROC曲线下面积为0.863（95%CI 0.779~0.946）,当截断值为0.515 ng/ml时血清PCT的敏感度为87.80%,特异度为86.10%。当hs-CRP的截断值为0.870 mg/dl时,敏感度为83.70%,特异度为80.60%。结论肝衰竭伴SBP的发生可能与患者性别、年龄无关,但可能与患者肝病基础类型有一定关系;肝衰竭伴SBP患者的PCT及hs-CRP水平比不伴SBP患者高,NE%对肝衰竭并发SBP无明显诊断价值;PCT对肝衰竭伴SBP的诊断价值相较hs-CRP具有更高的诊断价值,且诊断结果可靠。

Objective To investigate the the clinical diagnostic/application value of blood procalcitonin（PCT）,high-sensitivity C-reactive protein（hs-CRP） and neutrophil ratio（NE%） in liver failure complicated with spontaneous bacterial peritonitis（SBP） to effectively control liver failure progress and improve the prognosis of liver failure.Methods 85 cases patients from our hospital in September2013 to July 2015 of liver failure were collected,which included liver failure complicated with spontaneous bacterial peritonitis（SBP）（49 cases） as observation group and liver failure without SBP peritonitis as control group（36 cases）,to detect procalcitonin,hs-C-reactive protein and neutrophil ratio for all patients admitted to hospital within 24 hours,compared to the two groups of patients with the level of serum PCT,hs-CRP and neutrophil ratio,and the results of indicators were statistically analyzed by using SPSS 17.0.Results There had no difference（P〈0.05） between Liver failure group and non-SBP group in gender,age composition ratio.Compared with the non-SBP group,the level of PCT,hs-CRP were significantly higher（P〉0.05）,the ratio of neutrophils also increased（P〈0.05）;the area under the ROC curve of PCT was 0.871（95%CI 0.789-0.953）,the area under the ROC curve of hs-CRP was 0.863（95%CI 0.779-0.946）,when the cutoff value of serum PCT was 0.515 ng/ml,the sensitivity was 87.80%,the specificity was 86.10%.When the hs-CRP cutoff value was 0.870 mg/dl,the sensitivity was 83.70%,the specificity was 80.60%.Conclusion There has no significant difference between with SBP or non-SBP in gender and age,but there are some relationships with basic types of liver disease;the levels of PCT and hs-CRP in liver failure patients with SBP are higher than non-SBP group,but neutrophil ratio had no diagnostic value to provide the basis for clinical diagnosis of liver failure with SBP.Compared to hs-CRP,PCT has a higher diagnostic value and is more reliable.