血清降钙素原和C反应蛋白对肝硬化腹水自发性细菌性腹膜炎的诊断价值

Diagnostic value of blood procalcitonin and C-reactive protein in liver cirrhosis ascites spontaneous bacterial peritonitis

目的观察C反应蛋白(CRP)和降钙素原(PCT)对肝硬化腹水自发性细菌性腹膜炎(SBP)的诊断价值。方法回顾性分析2016年1月~2018年12月在吉林省肝胆病医院住院且入院后同时检测血PCT、CRP、腹水常规和腹水培养的86例肝硬化腹水患者临床资料,SBP组52例,非SBP组34例,比较两组患者血清CRP、PCT水平,采用受试者工作曲线(ROC)分析血清CRP、PCT二项指标单独和联合检测对肝硬化腹水并SBP的诊断价值。结果SBP组血清CRP、PCT水平均显著高于非SBP组;52例SBP患者腹水培养阳性13例(25.0%),其中PMN≥250×10^6/L的SBP患者中培养阳性为6例(13.3%);CRP、PCT和CRP+PCT预测肝硬化腹水并SBP的曲线下面积分别为0.793、0.866、0.916,当血清CRP>46.3mg/L,PCT>0.54ng/mL时,肝硬化腹水患者发生SBP危险性越高;血清CRP联合PCT诊断肝硬化腹水并SBP的灵敏度和特异度分别为82.2%和92.3%。结论血清CRP联合PCT检测对肝硬化腹水并SBP具有较高的诊断价值,有利于SBP的早期诊断和治疗。

Objective To observe the diagnostic value of C-reactive protein(CRP)and procalcitonin(PCT)in liver cirrhosis ascites spontaneous bacterial peritonitis(SBP).Methods The clinical data of 86 cirrhotic ascites patients admitted to Hepatobiliary Hospital of Jilin from January 2016 to December 2018 and were tested for blood PCT,CRP,ascites routine and ascites culture at the same time after admission were retrospectively analyzed.They were divided into the SBP group(n=52)and the non-SBP group(n=34).The serum CRP and PCT levels of the two groups of patients were compared.The diagnostic value of serum CRP and PCT in cirrhotic ascites combined with SBP was analyzed by receiver operating characteristic curves(ROC).Results Serum CRP and PCT levels in the SBP group were significantly higher than those in the non-SBP group.Of 52 SBP patients,13 patients(25.0%)were positive for ascites culture,of which 6 patients(13.3%)were positive for SBP patients with PMN≥250×10^6/L;CRP,PCT and CRP combined with PCT predicted the area under the curve of cirrhosis ascites with SBP to be 0.793,0.866 and 0.916 respectively.When serum CRP was greater than 46.3mg/L and PCT was greater than 0.54ng/mL,the risk of SBP in cirrhosis ascites patients was higher.The sensitivity and specificity of serum CRP combined with PCT in diagnosing cirrhosis ascites and SBP were 82.2%and 92.3%respectively.Conclusion Serum CRP combined with PCT detection has high diagnostic value for ascites due to cirrhosis and SBP,which is conducive to the early diagnosis and treatment of SBP.