肝硬化并SBP患者外周血SAA、WBC/PLT、CD64及腹水CD64联合检测的意义

Significance of combined detection of peripheral blood SAA, WBC/PLT, CD64 and ascites CD64 in patients with liver cirrhosis and spontaneous bactrial peritonitis

目的 分析肝硬化并自发性细菌性腹膜炎(SBP)外周血淀粉样蛋白A(SAA)、白细胞计数(WBC)/血小板(PLT)、白细胞分化抗原64(CD64)及腹水CD64联合检测的意义。方法 2021年1月至2022年12月成都中医药大学附属医院收治的106例肝硬化并腹水患者,根据是否发生SBP分为SBP组49例和非SBP组57例,选取同期50名健康人为对照组。免疫透射比浊法测定外周血SAA,全自动血液分析仪测定WBC、PLT,流式细胞仪测定外周血及腹水CD64。比较3组外周血SAA、WBC/PLT、CD64及腹水CD64,并通过绘制受试者工作特征曲线(ROC)评价外周血SAA、WBC/PLT、CD64及腹水CD64对肝硬化并SBP的诊断效能。结果 SBP组外周血SAA、WBC/PLT、CD64及腹水CD64分别为(82.3±17.2)mg/mL、(0.4±0.2)、(13 126.3±90.1)mol/cell、(14 912.8±101.7)mol/cell,高于非SBP组的(11.2±3.4)mg/mL、(0.1±0.1)、(1083.9±61.4)mol/cell、(936.2±51.1)mol/cell,(P<0.05);SBP组外周血SAA、WBC/PLT、CD64显著高于对照组的(10.6±2.8)mg/mL、(0.1±0.1)、(1063.7±57.5)mol/cell,(P<0.05)。非SBP组与对照组外周血SAA、WBC/PLT、CD64比较差异无统计学意义(P>0.05)。SBP组治疗后外周血SAA、WBC/PLT、CD64及腹水CD64分别为(35.6±6.9)mg/mL、(0.3±0.1)、(3302.4±70.5)mol/cell、(4758.4±78.6)mol/cell,显著低于SBP组治疗前(P<0.05)。ROC曲线分析显示,外周血SAA、WBC/PLT、CD64及腹水CD64联合诊断肝硬化并SBP的敏感度为96.00%,AUC为0.930,均高于单独检测(P<0.05)。结论 肝硬化并SBP患者外周血SAA、WBC/PLT、CD64及腹水CD64异常增高,且联合检测对肝硬化并SBP的早期诊断价值高。

Objective The aim of this study was to assess the clinical relevance significance of simultaneous detection of peripheral blood amyloid A(SAA),WBC/PLT ratio,cluster of differentiation 64(CD64)and ascitic fluid CD64 in patients diagnosed with liver cirrhosis and spontaneous bacterial peritonitis(SBP).Methods Between January 2021 and December 2022,106 patients diagnosed with liver cirrhosis and ascites were admitted to our hospital.They were divided into two groups:the SBP group(49 cases)and non-SBP group(57 cases),based on the presence or absence of SBP.Additionally,50 healthy subjects comprised the control group.Peripheral blood SAA levels were quantified using immunoturbidimetry.WBC and PLT were assessed using a fully automatic blood analyzer.Peripheral blood CD64 and ascites CD64 levels were measured via fully automated flow cytometry.Comparative analyses of peripheral blood SAA,WBC/PLT ratios,and CD64 leves,both in blood and ascitic fluid were conducted across the three groups.The diagnostic efficacy of of peripheral blood SAA,WBC/PLT ratios,CD64 leves(both blood and ascitic fluid),individually and in combination,for identifying liver cirrhosis complicated by SBP was evaluated using receiver operating characteristic(ROC)curves.Results In the SBP group,peripheral blood SAA,WBC/PLT ratio,CD64,and ascites CD64 levels were(82.3±17.2)mg/mL,(0.4±0.2),(13126.3±90.1)mol/cell and(14912.8±101.7)mol/cell,respectively,which were significantly higher than those in the non-SBP group[(11.2±3.4)mg/mL,(0.1±0.1),(1083.9±61.4)mol/cell and(936.2±51.1)mol/cell,P<0.05].SAA,WBC/PLT ration,and CD64 levels in the peripheral blood of the SBP group were also significantly elevated compared to the control group[(10.6±2.8)mg/mL,(0.1±0.1)and(1063.7±57.5)mol/cell,P<0.05].However,no significant differences were observed in SAA,WBC/PLT ratio,and CD64 levels in peripheral blood between the SBP group and the control group(P>0.05).Following treatment,peripheral blood SAA,WBC/PLT ratio,CD64 and ascites CD64 levels in the SBP group decreased to(35.6±6.9)mg/mL,(0.3±0.1),(3302.4±70.5)mol/cell and(4758.4±78.6)mol/cell,respectively,which were significantly lower than those before treatment(P<0.05).ROC curve analysis demonstrated that the combined sensitivity of SAA,WBC/PLT ratio,CD64 and ascites CD64 in diagnosing cirrhosis and SBP was 96.00%,with an AUC of 0.930,which was significantly higher than that of individual detections(P<0.05).Conclusion Elevated levels of peripheral blood SAA,WBC/PLT ratio,CD64,and ascites CD64 are observed in patients with liver cirrhosis and SBP.The combined detection of these markers holds significant diagnostic value for identifying and managing liver cirrhosis complicated by SBP.