血降钙素原和C-反应蛋白对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎的诊断意义

Roles of serum procalcitonin and C-reactive protein in the diagnosis of nonneutrocytic aseitic spontaneous bacterial peritonitis in liver cirrhosis

目的探讨血降钙素原和CRP对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎（NASBP）的诊断价值。方法回顾性收集2012年1月至2015年1月收治的肝硬化腹水患者，分为NASBP组与非感染性腹水组，设立常规自发性细菌性腹膜炎（SBP）组为对照。组间数据比较采用t检验、秩和检验、卡方检验或Fisher确切概率法，ROC曲线和约登指数的比较采用z检验。通过ROC曲线评价降钙素原和CRP对NASBP的诊断意义。结果共收集NASBP组30例、非感染性腹水组51例和常规SBP组33例。NASBP组与常规SBP组降钙素原、CRP浓度[0．70（0．25～2．45）μg／L，（21.85±16．46）mg／L；0．90（0．33～3．56）μg／L，（31．78±26．74）mg／L]水平差异均无统计学意义（P均〉0．05），且均明显高于非感染性腹水组[0．20（O．07～0．40）μg／L，Z=-3．38，t=4．64；（7．19±7．04）mg／L，Z=-3．89，t=-5．17，P均〈0．05。降钙素原、CRP对NASBP的最佳诊断界值依次为0．43越／L、12．76mg／L。依据上述界值，降钙素原、CRP、两者串联、两者并联诊断NASBP的AUC值依次为0．725、0．848、0．737、0．806，两两比较差异均无统计学意义（P均〉0．05）；敏感度依次为70．0％、70．0％、53．3％、86．7％，并联诊断与其他各法比较，差异均有统计学意义（Fisher确切概率法，P均〈0．05），余两两比较，差异无统计学意义（P均〈0．05）。；特异度依次为76．5％、88．2％、94．1％、74．5％，降钙素原与并联、CRP与串联比较，差异无统计学意义，余两两比较，差异均有统计学意义（Fisher确切概率法，P均〈0．05）；约登指数依次为0．465、0．582、0．474、0．612，两两比较差异均无统计学意义（P均〉O．05）。结论血降钙素原、CRP及二者联合对NAsBP均有良好的诊断价值且各有优势，临床可根据实际需要合理选用。

Objective To investigate the diagnostic value of serum procalcitonin （PCT） and C-reactive protein （CRP） in nonneutrocytic ascitic spontaneous bacterial peritonitis （NASBP）. Methods From January 2012 to January 2015,patients with liver cirrhosis and ascites were restropectively enrolled. Patients were divided into NASBP group and non-infective ascites group. The receiver operating characteristics curve （ROC） was used for assessing diagnostic accuracy of serum PCT and CRP. Patients with conventional SBP were set as controls. Data between two groups were compared using t test, Rank sum test, 2 test or Fisher exact test. The areas under ROC curve or Youden indeces were compared using Z test. Results A total of 30 patients were collected in NASBP group, 51 patients in non-infective ascites group and 33 patients in conventional SBP group. There were no statistically significant differences in PCT and CRP levels between NASBP group and conventional SBP group [0.70（0.25±2.45）μg/L, （21. 85±16. 46） mg/L;0.90（0.33±3.56）μg/L,（31. 78±26. 74） mg/L] both P〉0.05, and were both significantly higher than those of non-infective ascites group （0. 20（0. 07±0. 40） μg/L, Z=3. 38,t=4. 64;（7.19±7. 04） mg/L,Z=-3.89,t=-5.17, both P〈0. 05）. The optimal cut-off value of PCT and CRP in the diagnosis of NASBP was 0.43 ng/mI, and 12.76 mg/L, respectively. According to the cut-off value above, PCT, CRP and PCT plus CRP in series and in parallel in the diagnosis of NASBP, the areas under curves were 0. 725, 0. 848, 0. 737 and 0. 806, respectively, and there was no significant difference in pairwise comparison between groups. The sensitivities were 70.0%, 70. 0% 53.3% and 86.7%, respectively, there were statistically significant differences between inparallel and any other method （Fisher exact test,all P〈 0.05）. And there was no statistically significant difference （all P〉0.05）. The specificities were 76. 5%, 88.2%, 94.1% and 74.5%, respectively. There was no statistically significant difference in PCT and CRP between combination in parallel and in series, while the differences in the other pairwise comparisons of combinations were statistically significant （Fisher exact test, P〈0. 05）. The Youden＇s indexes were 0. 465, 0. 582, 0. 474 and 0. 612, respectively, there was no statistically significant difference in pairwise comparison between groups （all P〉0.05）. Conclusions All of serum PCT, CRP and the combination of them have good diagnostic value in NASBP with their own advantages which should be selected based clinical needs.