探讨血清降钙素原和C反应蛋白检测对肝硬化腹水并发自发性细菌性腹膜炎的意义

The significance of serum procalcitonin and C-reactive protein in the diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis combined with ascites

目的 探讨血清降钙素原（PCT）和C反应蛋白（CRP）检测在肝硬化腹水并发自发性细菌性腹膜炎（SBP）的应用价值.方法 将98例肝硬化腹水患者按是否合并SBP分为SBP组（48例）和无SBP组（50例）,比较两组患者血清PCT、CRP水平.绘制受试者工作特征（ROC）曲线,评估血清PCT和CRP水平对肝硬化腹水患者并发SBP的预测价值.结果 SBP组血清PCT和CRP水平明显高于无SBP组[3.90（6.95）μg/L比0.50（0.43）μg/L和20.80（11.27）mg/L比10.87（6.22）mg/L],差异有统计学意义（P〈0.01）.ROC曲线分析结果显示,血清PCT和CRP水平的曲线下面积分别为0.924（95% CI 0.860~0.987）和0.852（95% CI 0.777~0.926）,预测肝硬化腹水患者并发SBP的临界值分别为0.81μg/L和13.89mg/L,敏感度分别为91.7%和85.4%,特异度分别为80.0%和70.0%.SBP组病死率明显高于无SBP组[20.83%（10/48）比6.00%（3/50）],差异有统计学意义（P〈0.05）.SBP组死亡患者血清PCT和CRP水平明显高于存活患者[13.00（10.90）μg/L比2.50（5.30）μg/L和35.40（31.22）mg/L比18.05（10.15）mg/L],差异有统计学意义（P〈0.01或〈0.05）.结论 血清PCT和CRP水平升高可作为肝硬化腹水患者并发SBP的重要诊断指标,并且对预后有一定的预测价值.

Objective To determine the role of serum procalcitonin（PCT）and C-reactive protein （CRP）in predicting spontaneous bacterial peritonitis（SBP）in patients with liver cirrhosis combined with ascites. Methods Ninety-eight patients with liver cirrhosis combined with ascites were enrolled, including 48 cases with SBP（SBP group）and 50 cases without SBP（non-SBP group）.The levels of serum PCT and CRP were compared between 2 groups.The receiver operating characteristic（ROC）curves were used to evaluate the diagnostic SBP value of PCT and CRP levels in patients with liver cirrhosis combined with ascites.Results The serum PCT and CRP levels in SBP group were significantly higher than those in non-SBP group：3.90（6.95）μg/L vs.0.50（0.43）μg/L and 20.80（11.27）mg/L vs.10.87（6.22）mg/L, and there were statistical differences（P〈0.01）.The ROC cures results showed that the areas under the curve of serum PCT and CRP levels were 0.924（95% CI 0.860-0.987）and 0.852（95% CI 0.777-0.926）, and the optimal cut-off of predicting SBP in patients with liver cirrhosis combined with ascites were 0.81 μg/L and 13.89 mg/L. The sensitivity was 91.7% and 85.4%, and the specificity was 80.0%and 70.0% respectively.The mortality in SBP group was significant higher than that in non-SBP group：20.83%（10/48）vs.6.00%（3/50）,and there was statistical difference（P〈0.05）.In SBP group,the serum PCT and CRP levels in death patients were significant higher than those in survival patients： 13.00 （10.90） μg/L vs. 2.50 （5.30） μg/L and 35.40 （31.22） mg/L vs. 18.05（10.15） mg/L, and there were statistical differences（P〈0.01 or〈0.05）.Conclusions The increase of serum PCT and CRP levels can be used as an important diagnostic index for SBP in patients with liver cirrhosis combined with ascites, and has predictive value for prognosis.