降钙素原检测在肝硬化并发自发性细菌性腹膜炎诊断中的应用价值

Diagnostic value of PCT in patients with liver cirrhosis complicated with spontaneous bacterial peritonitis

目的探讨血浆降钙素原(PCT)及腹水PCT对肝硬化合并自发性细菌性腹膜炎(SBP)患者的诊断价值.方法选择2016年3月至2018年3月阳泉市第三人民医院诊治的肝硬化腹水患者127例为研究对象,其中35例合并SBP者为观察组,92例未合并SBP者为对照组.检测和比较其腹水白细胞(WBC)、中性粒细胞(PMN)、PCT、血WBC及PCT的差异.分析血浆PCT和腹水PCT对肝硬化合并SBP的诊断效力.结果观察组腹水中PCT、WBC、PMN、血浆PCT及WBC水平分别为(1.15±0.38)ng/mL、(0.85±0.22)×109/L、(0.29±0.11)×109/L、(0.95±0.24)ng/mL、(11.83±3.21)×109/L,对照组PCT、WBC、PMN、血浆PCT及WBC水平分别为(0.60±0.26)ng/mL、(0.18±0.08)×109/L、(0.05±0.02)×109/L、(0.24±0.08)ng/mL、(6.21±2.05)×109/L,差异均有统计学意义(t=4.254、5.382、7.325、5.638、4.992,均P<0.05).血浆PCT与腹水PMN、腹水PCT、腹水WBC均呈明显正相关(r=0.658、0.624、0.598,均P<0.05);腹水PCT与腹水PMN、腹水WBC均呈明显正相关(r=0.523、0.693,均P<0.05).血浆PCT和腹水PCT诊断肝硬化合并SBP的ROC曲线线下面积分别为0.901和0.864,最佳阈值分别为0.92 ng/mL和1.01 ng/mL.血浆PCT对肝硬化合并SBP诊断的诊断敏感性(89.6%)及特异性(87.2%)均高于腹水PCT的(85.7%)及(82.9%).结论在肝硬化合并SBP的诊断中,血浆及腹水PCT均具有较高的诊断价值,且血浆PCT诊断价值更高.

Objective To investigate the diagnostic value of blood procalcitonin(PCT)and ascites PCT in patients with cirrhosis and spontaneous bacterial peritonitis(SBP).Methods From March 2016 to March 2018,127 patients with cirrhotic ascites in the Third People's Hospital of Yangquan were selected in the research,35 cases combined with SBP were selected as observation group,and 92 cases without SBP were selected as control group.The ascites white blood cells(WBC),neutrophils(PMN),PCT,blood WBC and PCT were detected and compared.The diagnostic efficiency of plasma PCT and ascites PCT in patients with cirrhosis combined with SBP was analyzed.Results The ascites levels of PCT,WBC,PMN,plasma PCT and WBC in the observation group were(1.15±0.38)ng/mL,(0.85±0.22)×109/L,(0.29±0.11)×109/L,(0.95±0.24)ng/mL,(11.83±3.21)×109/L,respectively,which in the control group were(0.60±0.26)ng/mL,(0.18±0.08)×109/L,(0.05±0.02)×109/L,(0.24±0.08)ng/mL,(6.21±2.05)×109/L,respectively,the differences were statistically significant(t=4.254,5.382,7.325,5.638,4.992,all P<0.05).The plasma PCT was positively correlated with the ascites PMN,the ascites PCT and the ascites WBC(r=0.658,0.624,0.598,all P<0.05),and the ascites PCT was positively correlated with the ascites PMN and the ascites WBC(r=0.523,0.693,all P<0.05).The area under the ROC curve of plasma PCT and ascites PCT in the diagnosis of cirrhosis combined with SBP was 0.901 and 0.864,respec-tively,with the best thresholds of 0.92ng/mL and 1.01ng/mL,respectively.The sensitivity(89.6%)and specificity(87.2%)of plasma PCT in diagnosis of cirrhosis combined with SBP were higher than those of ascites PCT(85.7%and 82.9%).Conclusion In the diagnosis of cirrhosis combined with SBP,plasma PCT and ascites PCT have high diagnostic potency,and plasma PCT has higher diagnostic value.