Presepsin在肝硬化自发性细菌性腹膜炎中的诊断价值

The diagnostic value of presepsin in spontaneous bacterial peritonitis of cirrhosis

目的探讨可溶性CD14分子亚型(Presepsin)在肝硬化自发性细菌性腹膜炎(SBP)患者诊断中的价值。方法选取2016年6月至2017年10月大连医科大学附属第一医院消化内科和感染科收治的符合肝硬化和SBP诊断标准的患者63例作为研究对象,根据疾病类型分为SBP组(n=21)、肝硬化腹水组(n=22)和单纯肝硬化组(n=20),后两组患者根据Child-Pugh评分进一步分为A级组(n=20)、B级组(n=13)和C级组(n=9),同时,选取健康志愿者作为对照组(n=48)。比较各组患者Presepsin水平,并绘制受试者工作特征曲线(ROC)。结果SBP组、肝硬化腹水组及单纯肝硬化组血Presepsin水平明显升高(P<0.05),且SBP组Presepsin高于肝硬化腹水组,肝硬化腹水组高于单纯肝硬化组(P<0.05);Presepsin对SBP诊断的ROC曲线下面积(AUC)为0.842,最佳截断点为520 pg/mL,敏感性及特异性分别为85.7%和77.3%。A级组、B级组和C级组Presepsin水平随Child-Pugh分级的增高而升高。结论Presepsin对于SBP有诊断价值,且可预测肝硬化患者肝脏损害的严重程度。

Objective To investigate the value of soluble CD14 molecular subtype(presepsin)in the diagnosis of patients with spontaneous bacterial peritonitis(SBP)of cirrhosis.Methods 63 patients who met the diagnostic criteria of liver cirrhosis and SBP admitted to the Gastroenterology and Infectious Disease Department of the First Affiliated Hospital of Dalian Medical University from June 2016 to October 2017 were selected as reseach subjects.They were divided into SBP group(n=21)、cirrhosis ascites group(n=22)and simple cirrhosis group(n=20)according to the type of disease,the latter two groups were further divided into class A group(n=20),class B group(n=13)and class C group(n=9)according to Child-Pugh score.As the same time,selected Healthy volunteers as the control group(n=48).Compared the presepsin difference among the groups and draw the receiver operating characteristic(ROC)curves.Results Presepsin were significantly increased in the groups of SBP,cirrhosis ascites and simple cirrhosis(P<0.05);the presepsin level of cirrhosis ascites group was lower than the SBP group,and higher than the simple cirrhosis group(P<0.05).The area under ROC curve of presepsin which had the diagnostic value of SBP is 0.842.The best cut-off point was 520 pg/mL,and the sensitivity and specificity were 85.7%and 77.3%respectively.The levels of presepsin in the Class A,B,and C groups increased with the increase of the Child-Pugh classification.Conclusion Presepsin is valuable for the diagnosis of SBP,and presepsin can predict the severity of liver damage in patients with cirrhosis.