腹水中的中性粒细胞明胶酶相关脂质运载蛋白和乳酸脱氢酶检测在诊断肝硬化自发性腹膜炎中的价值

Assessment of neutrophil gelatinase-associated lipocalin and lactate dehydrogenase in ascities for the screening of spontaneous bacterial peritonitis in cirrhosis

目的:腹水中有核细胞计数及分类仍然是目前诊断肝硬化自发性细菌性腹膜炎(SBP)的标准。然而,这种方法有其缺点,因此使用其他腹水中可检测指标可能是诊断SBP的有益的选择。方法:测定肝硬化患者腹水中的中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、乳酸脱氢酶(LDH),评估NGAL、LDH对SBP的诊断价值。结果:共对52例肝硬化腹水标本进行检测分析,其中13例(25%)中性粒细胞数≥250/μl诊断为SBP,患者腹水中NGAL和LDH的中位浓度分别为243ng/ml和565 U/L,分别是非SBP患者的2.7和3倍(P<0.05)。NGAL诊断SBP的ROC曲线下的面积是0.87,LDH的曲线下面积为0.86,两者联合检测(均高于临界值)的曲线下的面积为0.87。NGAL≥122.5ng/ml时其敏感性和特异性分别为1.00和0.77,LDH≥120U/L时其敏感性和特异性分别为0.92和0.69,两者检测均高于临界值的敏感性和特异性分别为0.85和0.90。结论:通过本次研究表明,检测腹水中NGAL和LDH有可能成为筛查肝硬化腹水患者并发SBP的有效手段之一。

Objective：Enumeration and classification of nucleated cells in peritoneal fluids remains the standard for diagnosing spontaneous bacterial peritonitis（SBP） of liver cirrhosis.However,this method has several drawbacks,so that the test of other peritoneal fluid indicators may be an alternated option for screening of SBP.methods;Neutrophil gelatinase- associated lipocalin（NGAL）,lactate dehydrogenase（LDH） were assessed in ascities from patients with liver cirrhosis.As the diagnosed slandard of SBP.The diagnostic value of NGAL,LDH in SBP was assessed.Results;52 specimens were analyzed,13 of which（25%） with PMN count≥250/μX.The median concentration of NGAL and LDH were 243ng/mL and 565U/L in samples of SBP separately,which were 2.7 and 3 fold higher than that in samples with 250PMN/μX.The area under ROC curve was 0.87 for NGAL,0.86 for LDH and 0.87 for their combination（both above the cutoff value）.Sensitivities and specificities were 1.00 and 0.77 for NGAL≥122.5 ng/mL,0.92 and 0.69 for LDH 3=120U/L,0.85 and 0.90 for their combination.Conclusion：These results suggest that assessment of NGAL in peritoneal fluids,especially in combination with LDH,may be a reliable approach for screening of SBP in ascitic patients with liver cirrhosis.