血浆降钙素原及内毒素水平与肝硬化伴自发性细菌性腹膜炎的关系

Relationship between plasma levels of procalcitonin endotoxin and spontaneous bacterial peritonitis in liver cirrhosis.

探讨血浆降钙素原(procalcitonin,PCT)及内毒素水平对肝硬化伴自发性细菌性腹膜炎(spontaneous bacte-rial peritonitis,SBP)的诊断价值及与病原菌分型和临床预后的关系。肝硬化腹水患者(合并SBP38例,单纯腹水51例)血浆PCT含量和内毒素水平分别采用金标兔疫层析和分光光度法检测。所有患者PCT及内毒素水平均显著高于正常,SBP组PCT阳性检出率(>10ng/ml)及内毒素水平均显著高于无SBP组(P<0.001)。G菌感染组血浆内毒素水平显著高于G^+菌感染组(P<0.01),两组PCT阳性检出率分别为100％与88.9％,差异未见显著性(P>0.05)。动态观察最初三天血浆PCT的变化对不同结局的预测性及临床疗效的指导性优于内毒素检测。动态观察PCT及内毒素水平对肝硬化伴SBP的早期诊断、病原菌初步分型、临床疗效评估和预后判断等都有重要价值。

To investigate the diagnostic value of plasma procalcitonin (PCT) and endotoxin for spontaneous bacterial peritonitis ( SBP) in liver cirrhosis, studying the relationship between them and pathogen typing, clinical prognosis. The plasma levels of PCT and endotoxin in 89 patients with cirrhotic ascites( with SBP 38 and without 51) were measured by gold immunochrornatographic assay and fluorometric method, respectively. Plasma levels of PCT and endotoxin were significantly raised above normal value in all patients. The positive rate of PCT ( > 10ng/ml) and levels of endotoxin were significantly higher in SBP group than those in without SBP group (P< 0.001). Plasma levels of endotoxin were remearkably higher with G~ bacterial infection than that with G+ bacterial infection ( P < 0.01) ,and there was no significant difference on the positive rate of PCT( 100% vs 88.9% , P >0.05) . Dynastic observe the variation of plasma PCT in the first three days was superior to endotoxin in the predictability to different outcome and the guidance of clinical treatment. Dynastic detection of PCT and endotoxin has important value in early diagnosis, pathogen initiative typing, evaluation therapy and judgement prognosis of SBP in liver cirrhosis.