血清PCT、CRP检测在肝硬化自发性细菌性腹膜炎诊断中的意义

Diagnostic value of serum PCT and CRP for spontaneous bacterial peritonitis in patients with liver cirrhosis

目的:探讨血清血浆降钙素原(plasma calcitonin,PCT)及C反应蛋白(C-reactive protein,CRP)对肝硬化腹水自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的预判价值.方法:回顾性分析永康市第一人民医院2011-01/2016-01收治的168例肝硬化患者的临床资料.根据是否出现SBP,分为SBP组和非SBP组,比较两组患者的临床资料,评估其发生SBP的预测因子,选取有统计学意义的指标构建受试者工作特征(receiver operating characteristic,ROC)曲线,评价其敏感度和特异性.结果:SBP组与非SBP组血清ALT、AST、白细胞计数及中隆粒细胞比率的比较,差异无统计学意义(P>0.05);SBP组PCT、CRP明显高于非SBP组,差异有统计学意义(P<0.05).ROC曲线分析PCT、CRP对应曲线下面积分别为0.951、0.868,计算所对应诊断准确度最高的临界值分别为1.9 ng/mL、22.6 mg/L,敏感度分别为89.1%、86.3%,特异度分别为81.7%、80.6%.结论:PCT及CRP的升高对肝硬化腹水SBP有较大的早期预判价值.

AIM：To assess the value of serum procalcitonin（PCT） and C-reactive protein（CRP） for ascites spontaneous bacterial peritonitis（SBP） in patients with liver cirrhosis and ascites.METHODS：The clinical data for 168 patients with liver cirrhosis and ascites treated at our hospital from January 2011 to January 2016 were retrospectively analyzed.According to the presence of SBP or not,the patients were divided into two groups：SBP group and non-SBP group.Factors that can predict the development of SBP were evaluated.The receiver operating characteristic（ROC） curves for significant parameters were generated to assess their sensitivities and specificities for diagnosis of SBP.RESULTS：Serum ALT,AST and white cell count did not differ significantly between the SBP group and non-SBP group（P〉0.05）.Serum PCT and CRP in the SBP group were significantly higher than those in the non-SBP group（P〈0.05）.The ROC curve analysis showed that the areas under the ROC curves of PCT and CRP were 0.951 and 0.868,respectively.Using the cut-off values of 1.9ng/mL and 22.6 mg/ L,the sensitivities were89.1%and 86.3%,and specificities were 81.7%and 80.6%,respectively.CONCLUSION：Abnormally elevated serum PCT and CRP are of significant value for predicting SBP in patients with liver cirrhosis and ascites.