肝硬化腹水合并自发性细菌性腹膜炎的临床分析

Clinical Analysis of Cirrhotic Ascites Complicated with Spontaneous Bacterial Peritonitis

目的探讨肝硬化腹水合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)有益的早期诊断指标。方法收集从2015年6月~2018年12月就诊于华中科技大学同济医学院附属协和医院、武汉大学附属中南医院的225例肝硬化腹水患者的临床资料,根据目前公认的诊断标准将其分成SBP组和非SBP组,分析患者的一般资料、实验室生化及腹水等指标。结果肝硬化腹水患者中并发SBP的发生率为11.11%(25/225)。肝硬化腹水合并SBP组和非SBP组患者在性别、外周血白细胞计数、外周血中性粒细胞计数、血清C反应蛋白(CRP)、血清铁蛋白、腹水总蛋白、血清腹水白蛋白梯度(SAAG)、腹水腺苷脱氨酶(ADA)、腹水乳酸脱氢酶(LDH)上差异有统计学意义(均P<0.05)。进一步分析血清CRP水平诊断肝硬化腹水并发SBP的ROC曲线下面积为0.783,在截断值为18.3 mg/L,其灵敏度为80.0%、特异度为70.0%;血清铁蛋白水平ROC曲线下面积为0.746,最佳截断值为320.9μg/L,灵敏度为100.0%、特异度为56.4%;腹水ADA水平ROC曲线下面积为0.744,最佳截断值为4.5 U/L,其灵敏度为60.0%、特异度为74.5%;腹水LDH水平ROC曲线下面积为0.853,最佳截断值为99.5 U/L,其灵敏度为80.0%、特异度为86.5%。结论血清CRP、血清铁蛋白水平升高提示临床医生应尽早行腹腔穿刺术,明确肝硬化腹水患者是否并发SBP;腹水乳酸脱氢酶对于SBP有诊断价值。

Objective To investigate valuable diagnostic indicators for liver cirrhosis complicated with spontaneous bacterial peritonitis(SBP).Methods Clinical data of 225 patients with liver cirrhosis ascites admitted in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Zhongnan Hospital Affiliated to Wuhan University from June 2015 to December 2018 were collected.According to currently accepted diagnostic criteria,the study subjects were divided into SBP group and non-SBP group.The general information,laboratory biochemistry and ascites indicators of patients were analyzed.Results The incidence of SBP was 11.11%(25/225).There were significant differences in gender,peripheral blood leukocyte count,peripheral blood neutrophil count,serum C-reactive protein(CRP),serum ferritin,ascitic total protein,serum ascites albumin gradient(SAAG),ascitic adenosine deaminase(ADA),and ascitic lactate dehydrogenase(LDH)between SBP group and non-SBP group(all P<0.05).The area under the ROC curve of serum CRP level in diagnosis of cirrhotic ascites complicated with SBP was 0.783.At the cutoff value of 18.3 mg/L,the sensitivity was 80.0%,and the specificity was 70.0%.The area under the ROC curve of serum ferritin was 0.746.At the cutoff value of 320.9μg/L,the sensitivity was 100.0%,and the specificity was 56.4%.The area under the ROC curve of ascitic ADA level was 0.744.At the cutoff value of 4.5 U/L,the sensitivity was 60.0%,and the specificity was 74.5%.The area under the ROC curve of ascitic LDH level was 0.853.The cutoff value was 99.5 U/L,the sensitivity 80.0%,and the specificity 86.5%.Conclusion Serum CRP and serum ferritin are valuable indicators for guiding paracentesis and diagnosis of cirrhotic ascites complicated with SBP in clinical practice.Ascitic LDH is valuable for the diagnosis of SBP.