自发性细菌性腹膜炎的病例对照研究

Control Study of Spontaneous Bacterial Peritonitis

目的自发性腹膜炎（Spontaneous bacterial peritonitis,SBP）是肝硬化腹水患者易发生的严重致死性的感染。早期评估SBP发生的危险,预防性使用抗生素是减少SBP死亡的重要手段。本研究通过回顾性病例对照研究,评价了现有实验室指标诊断SBP能力。方法入选2015年1~12月在太原市第三人民医院诊断的180例失代偿肝硬化患者,其中男116例,女64例。将入选患者分为SBP组（100例）和非SBP组（80例）比较现有实验室指标检测结果的差异,并通过绘制受试者工作特征曲线（Receiver Operator Characteristic Cure,ROC）曲线,分析其诊断SBP的敏感性和特异性。结果 WBC（Z=-2.023,P=0.043）、NEU%（Z=-2.216,P=0.027）、ALB（Z=-3.416,P=0.001）、TBIL（Z=-2.056,P=0.040）、DBIL（Z=-2.890,P=0.004）、PT（Z=-3.690,P〈0.000 1）、PT-INR（Z=-3.090,P=0.001）、PT-A（Z=-3.531,P〈0.000 1）和PCT（Z=-3.352,P=0.001）在SBP组和非SBP组统计学差异具有显著性;而PLT、TP、AST、ALT、APTT、FIB、TT两组比较差异不具有统计学意义（P〉0.05）。并且,ALB≤30 g/L,PCT〉0.2 ng/ml,PT-A≤62%和TBIL〉54μmol/L时,诊断SBP的敏感性分别为88%、68%、88%和44%,特异性分别为65%、80%、60%和90%。且ALB,PT-A和PCT联合诊断SBP的灵敏度为99.5%,特异度为31.2%。结论联合使用ALB,PT-A和PCT评价有腹水的失代偿肝硬化患者发生SBP的危险,可能有助于提高早期诊断SBP的能力,从而减少SBP导致的死亡。

Objective Spontaneous bacterial peritonitis（SBP） is a severe and often fatal infection in patients with cirrhosis and ascites. It is important for minimizing the mortality of these patients that early evaluation of the risk of SBP and administration of antibiotic. We assessed the ability of the available laboratory information in diagnosis of SBP. Methods 180 cases of patients with cirrhosis and cirrhosis were selected in the third people＇s Hospital of Taiyuan city from January to December 2015, including 116 males and 64 females, were classified in two groups： SBP group（100 patients） and non-SBP group（80 patients）. Currently available laboratory tests were compared between them and receiver operator characteristic cure（ROC） were made to analysis their sensitivity and specificity in diagnosing SBP. Results WBC（Z=-2.023, P=0.043）, NEU%（Z=-2.216, P=0.027）, ALB（Z=-3.416, P=0.001）, TBIL（Z=-2.056, P=0.040）, DBIL（Z=-2.890, P=0.004）, PT（Z=-3.690, P〈0.000 1）, PT-INR（Z=-3.090, P=0.001）, PT-A（Z=-3.531, P〈0.000 1） and PCT（Z=-3.352, P=0.001） are significantly different between SBP group and non-SBP group, while PLT, TP, AST, ALT, APTT, FIB, TT are not（P〉0.05）. Moreover, taking ALB ≤ 30 g/L, PCT〉0.2 ng/m L, PT-A ≤ 62% and TBI〉L54 μmol/L as cut-off value for SBP, their sensitivity are 88%, 68%, 88% and 44%, respectively, and their specificity are 65%, 80%, 60% and 90%, respectively. In addition, if ALB, PT-A and PCT are combined to diagnose SBP, their combined sensitivity and specificity are 99.5% and 31.2%, respectively. Conclusion It might be improve the ability of early diagnosis SBP and reduce the mortality that ALB, PT-A and PCT are combined to diagnose SBP.