肝硬化患者腹水中TNF-α和sICAM-1水平与其并发SBP的关系及临床意义

Relationship and Clinical Significance between the Level of TNF-α and sICAM-1 in Ascites for Patients with Cirrhosis and Combined SBP for Cirrhosis

目的:探讨肝硬化患者腹水中肿瘤坏死因子(TNF-α)和可溶性细胞黏附因子-1(sICAM-1)水平与其并发细菌性腹膜炎(SBP)的关系以及临床意义。方法:选择2013年11月-2016年11月在本院就诊的70例肝硬化合并腹水患者,根据是否并发SBP分为两组,其中30例并发SBP(SBP组),40例患者无SBP(无SBP组),采用酶联免疫吸附测定法(ELISA)对两组患者腹水中的TNF-α和sICAM-1水平进行检测和对比。结果:SBP组患者腹水及血清中TNF-α、sICAM-1水平分别为(186.24±19.32)ng/m L和(467.93±30.45)ng/m L,均明显高于无SBP组的(66.12±10.34)ng/m L和(103.25±17.38)ng/m L,差异均有统计学意义(P<0.05)。同时SBP组降钙素原(PCT)、IL-6水平均较无SBP组明显要高,差异均有统计学意义(P<0.05)。以TNF-α参考值诊断,SBP组阳性27例,无SBP组阳性7例,诊断灵敏性90.0%(27/30),特异性82.5%(33/40),准确率为85.7%(60/70);以sICAM-1参考值诊断,SBP组阳性28例,无SBP组组阳性9例,诊断灵敏性93.3%(28/30),特异性为77.5%(31/40),准确率为84.3%(59/70)。结论:对于肝硬化腹水患者,若并发SBP其TNF-α和sICAM-1水平均会明显升高,因此可以通过对TNF-α和sICAM-1水平的检测来鉴别患者是否并发SBP,值得临床推广。

Objective： To investigate the relationship and the clinical significance between the level of tumor necrosis factor （ TNF- α ） and soluble cell adhesion molecules-1 （ sICAM-1 ） in aseites for patients with cirrhosis and combined bacterial peritonitis （ SBP ） .Method： A total of 70 patients combined liver cirrhosis with ascites in our hospital from November 2013 to November 2016 were divided into two groups according to combined SBP with 30 case of combined SBP （ SBP Group ）, and 40 cases of patients without SBP （ non-SBP group ） .The enzymelinked immunosorbent assay （ ELISA ）method was adopted to detect and compare the level of TNF- α and sICAM-1 in ascites for patients of two groups.Result： The level of TNF- α and sICAM- 1 for patients with ascites of SBP group were （ 186.24 ± 19.32 ） ng/mL and （ 467.93 ± 30.45 ） ng/mL, which were significantly higher than （ 66.12 ± 10.34 ） ng/mL and （ 103.25± 17.38 ） ng/mL of non-SBP group, the differences were statistically significant （ P〈0.05 ） . At the same time, the levels of procalcitonin （ PCT ） and IL-6 of SBP group were significantly higher than those of non-SBP group, the differences were statistically significant （ P〈0.05 ） .The diagnosis was done with the reference value of TNF- α with 27 cases of positive in SBP group and 7 cases of positive in non-SBP group.The diagnostic sensitivity was 90.0% （ 27/30 ）, the specificity was 82.5% （ 33/40 ）, and the accuracy rate was 85.7% （ 60/70 ） . The diagnosis was done with the reference value of slCAM-1 with 28 cases of positive in SBP group and 9 cases of positive in non-SBP group.The diagnostic sensitivity was 93.3% （ 28/30 ）, the specificity was 77.5% （ 31/40 ）, and the accuracy rate was 84.3% （ 59/70 ） .Conclusion： For patients with liver cirrhosis ascites, if the concurrence is SBP, the levels of TNF-a and sICAM-1 will increase obviously.Therefore, the level test of TNF-α and sICAM-1 can be applied in patients to test if patients have combined SBP, which is worthy of clinical promotion.