病毒性肝炎肝硬化腹水细菌性腹膜炎患者血清降钙素原水平的变化

Change of serum procalcitonin level in patients with viral hepatitis,ascites due to cirrhosis and bacterial peritonitis

目的探讨病毒性肝炎肝硬化腹水细菌性腹膜炎患者检测血清降钙素原(PCT)的临床价值。方法选取195例病毒性肝炎肝硬化腹水患者,根据是否合并细菌性腹膜炎将上述患者分为观察组90例、对照组105例,观察组合并细菌性腹膜炎,对照组未合并细菌性腹膜炎。所有患者均接受血清PCT、C反应蛋白(CRP)以及全血白细胞计数(WBC)检测。结果治疗前,观察组血清PCT、CRP、全血WBC显著高于对照组(P<0.05)。出院时,2组患者血清PCT、CRP、全血WBC均显著下降(P<0.05),但2组患者血清PCT、CRP、全血WBC比较无显著差异(P>0.05)。绘制受试者工作特征曲线(ROC曲线),血清PCT诊断病毒性肝炎肝硬化腹水细菌性腹膜炎的ROC曲线下面积(AUC)显著大于血清CRP、全血WBC(P<0.05)。全血WBC诊断病毒性肝炎肝硬化腹水细菌性腹膜炎的灵敏度显著低于血清PCT、CRP(P<0.05)。血清CRP诊断病毒性肝炎肝硬化腹水细菌性腹膜炎的特异度显著低于血清PCT、全血WBC(P<0.05)。结论治疗前检测血清PCT对病毒性肝炎肝硬化腹水细菌性腹膜炎的诊断具有良好的临床应用价值。

Objective To explore the clinical value of serum procalcitonin（ PCT） detection in patients with viral hepatitis,ascites due to cirrhosis and bacterial peritonitis. Methods A total of195 patients with viral hepatitis,ascites due to cirrhosis were selected and divided into observation group（ n = 90,with bacterial peritonitis） and control group（ n = 105,without bacterial peritonitis）.All patients were treated with serum PCT,C reactive protein（ CRP） and whole blood white blood cell count（ WBC） detections. Results Before treatment,serum CRP,PCT,whole blood WBC of the observation group were significantly higher than those of the control group（ P〈0. 05）. After treatment,serum PCT,CRP,whole blood WBC in both groups significantly decreased（ P〈0. 05）. The area under the PCT curve（ AUC） of serum ROC in the diagnosis of viral hepatitis,ascites due to cirrhosis and bacterial peritonitis was significantly greater than that of serum CRP and whole blood WBC（ P〈0. 05）. The sensitivity of whole blood WBC in the diagnosis of viral hepatitis,ascites due to cirrhosis and bacterial peritonitis was significantly lower than that of serum PCT,CRP（ P〈0. 05）. The specificity of serum CRP in the diagnosis of viral hepatitis,ascites due to cirrhosis and bacterial peritonitis was significantly lower than that of serum PCT and whole blood WBC（ P〈0. 05）. Conclusion Detection of serum PCT before treatment has a good clinical application value in the diagnosis of patients with viral hepatitis,ascites due to cirrhosis and bacterial peritonitis.