肝硬化腹水患者合并细菌感染病原菌与PCT和NEU研究

Detection of procalcitonin and neutrophil percentage in cirrhosis ascites with bacterial infection and its pathogenic bacteria

目的探讨肝硬化腹水患者合并细菌感染病原菌与血清降钙素原(PCT)和中性粒细胞百分比(NEU%)水平及临床意义。方法选取2016年10月-2018年3月河北医科大学第三医院接收的135例肝硬化腹水患者作为研究对象。根据患者腹水培养结果,分为感染组和未感染组,其中感染组65例患者,未感染组70例患者。检查两组患者血清PCT、内毒素(EXT)、白细胞(WBC)、多型核白细胞(PMN)及NEU%,并进一步分析两组患者血清指标及腹水指标的表达情况,依照医院感染诊断标准,根据病原菌检测结果,对血清PCT、EXT检测结果在诊断中的敏感性与特异性进行分析。结果感染组患者PCT、EXT、WBC、PMN及NEU%分别为(3.78±2.21)ng/ml、(11.44±5.32)pg/ml、(3.92±2.01)×10^9L、(2.65±1.78)×10^9L、(90.45±2.88)%高于未感染组(P<0.001)。65例感染患者腹水中共培养分离病原菌83株,其中革兰阴性菌50株占60.24%,以大肠埃希菌为主;革兰阳性菌33株占39.76%,以粪肠球菌为主。65例患者中单菌感染48例,复合菌感染17例,其中革兰阴性菌与革兰阳性菌复合感染11例,两种革兰阴性菌感染和两种革兰阳性菌感染分别为3例。在诊断腹水感染时,阳性标准为PCT≥0.5 ng/ml,EXT≥10 pg/ml。PCT和EXT检测敏感性分别为93.85%、80.00%,检测特异性分别为88.13%、92.91%。结论肝硬化腹水合并细菌感染以大肠埃希菌和粪肠球菌为主,肝硬化腹水合并细菌感染导致PCT、EXT、WBC、PMN以及NEU%均升高,且PCT、EXT具有较高的敏感度和特异度,因此可作为诊断鉴别腹水感染快速而准确的辅助指标,具有一定的临床价值。

OBJECTIVE To investigate the levels and clinical significance of pathogens,serum procalcitonin(PCT)and neutrophil percentage(NEU%)in cirrhotic ascites complicated with bacterial infection.METHODS Totally 135 patients with ascites due to cirrhosis treated in the Third Hospital of Hebei Medical University from Oct.2016 to Mar.2018 were selected and divided into two groups according to the results of ascites culture,with 65 patients in the infected group and 70 patients in the uninfected group.After admission,serum procalcitonin(PCT),endotoxin(EXT),white blood cell(WBC),polymorphonuclear leukocyte(PMN)and neutrophil percentage(NEU%)were detected in both groups.The expression levels of serum indexes and ascites indexes were further analyzed.According to the diagnostic criteria of nosocomial infection and pathogenic bacteria detection results,the sensitivity and specificity of serum PCT,EXT detection results in the diagnosis were analyzed.RESULTS The PCT,EXT,WBC,PMN and NEU%of the infected group were(3.78±2.21)ng/m,(11.44±5.32)pg/ml,(3.92±2.01)×10^9L,(2.65±1.78)×10^9L,(90.45±2.88)%,which were higher than those of the uninfected group(P<0.001).A total of 83 strains of pathogenic bacteria were isolated from the ascites of the 65 patients,of which 50(60.24%)were Gram-negative bacteria,mainly Escherichia coli(27.71%)and 33(39.76%)were Gram-positive bacteria,mainly Enterococcus faecalis(13.25%).Among the 65 patients,48 had single bacterial infection and 17 had complex bacterial infection.Among them,11 were infected with Gram-negative bacteria and Gram-positive bacteria,3 were infected with two Gram-negative bacteria,and another 3 were infected with two Gram-positive bacteria.In the diagnosis of ascites infection,the positive standard was PCT≥0.5 ng/ml,and EXT≥10 pg/ml.The sensitivity of PCT and EXT detection was 93.85%and 80%respectively,and the specificity of detection was 88.13%and 92.91%respectively.CONCLUSION E.coli and E.faecium are the main pathogens of bacterial infections in cirrhotic ascites.PCT,EXT,WBC,PMN and Neu%of bacterial infections in cirrhotic ascites are elevated,and PCT and EXT have high sensitivity and specificity.Therefore,they can be used as a rapid and accurate auxiliary indicators for the diagnosis and identification of ascites infection,which is worthy of clinical application.