摘要
目的 探讨血浆降钙素原（PCT）测定在晚期肝病自发性细菌性腹膜炎（SBP）中的诊断价值.方法 回顾性分析了2011年3月至2013年6月在重庆医科大学附属第二医院感染病科住院且入院后查PCT的362例晚期肝病腹水患者的临床资料,将其分为SBP组（n=178）和非SBP组（n=184）.比较两组患者入院时的PCT水平及SBP组抗感染治疗后血浆PCT的动态变化情况,采用受试者工作特征曲线分析PCT诊断SBP的临床参考值及敏感性和特异性.结果 SBP组腹水培养阳性率为4.6%（4/87）.SBP组和非SBP组治疗前血浆PCT中位值分别为0.73和0.15 ng/ml,差异有统计学意义（Z=-11.9,U=0.000）.SBP组中有13例患者同时血培养阳性,其血浆PCT中位值为1.73 ng/ml,高于SBP组.SBP组抗感染治疗有效的病例中抗感染治疗后3、5、7 d,分别有46、19和25例患者的血浆中位PCT值下降为0.40、0.32和0.33 ng/ml,明显低于其抗感染治疗前的0.86（Z=-5.91,U=0.000）、0.72（Z=-3.10,U=0.002）和0.79 ng/ml（Z=-4.37,U=0.000）.PCT诊断SBP的临床参考值为0.462 ng/ml（AUC=0.95,P=0.00,95% CI=0.928～0.972）,敏感性为83.7%,特异性为94.9%.结论 SBP患者腹水培养阳性率低,PCT诊断SBP的敏感性及特异性较高.感染越重,PCT值越高,其动态变化可作为判断SBP抗感染治疗是否有效的指标.
Objective To explore the clinical value of serum procalcitonin （PCT） for predicting spon- taneous bacterial peritonitis （SBP） in end-stage liver diseases. Methods The clinical data of 362 ascitic inpa- tients with end-stage liver diseases who had underwent serum PCT assay in our department from March 2011 to June 2013 were analyzed retrospectively. These patients were then divided into SBP group （ n = 178 ） and non- SBP group （ n = 184 ） . The dynamic changes of the PCT values upon admission and after antibiotic treatment were compared. The receiver operating characteristic curve was drawn to identify the optimal cut-off value of Serum PCT in diagnosing SBP. Results The positive rate of bacteria culture in ascites was only 4. 6% （4/87） in SBP group. The median value of serum PCT was 0. 73 and 0. 15 ng/ml in SBP group and non-SBP group （Z = - 11.9,U=0. 000）, respectively, before antibiotic treatment. In the SBP group, the median value of serum PCT was 1.73 ng/ml in 13 patients with positive culture findings, which was higher than the overall median value in SBP group. Among patients who were responsive to the antibiotic therapy, the median values of serum PCT were 0. 40 （ n = 46） , 0. 32 （n = 19） , and 0. 33 ng/ml （n = 25）, respectively, 3, 5, and 7 days after the effective an- tibiotics treatment, which were significantly lower than the pre-treatment levels [0.86 （Z = -5.9l, U = 0.000）, 0.72 （Z=-3.10, U=0.002）, and 0.79 ng/ml （Z=-4.37, U=0. 000）, respectively]. ROC analysis showed that a serum PCT value of more than 0. 462 ng/ml had a sensitivity of 83.7% and a speci- ficity of 94.9% （AUC： 0.95, 95% CI： 0. 93-0. 97, P =0. 00） in diagnosing SBP in patients with end-stage liver diseases. Conclusions Ascitic fluid positive rate is low in SBP patiens. Serum PCT is a sensitive and spe- cific marker for predicting peritoneal bacteria infection in end-stage liver disease patients with ascites. Higher ser- um PCT can be expected in these patients with heavier infections, it can also be used to evaluate the effectiveness of anti-bacteria therapies.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2014年第1期37-41,共5页
Acta Academiae Medicinae Sinicae
基金
国家自然科学基金(30100158
31000397)
重庆市科委自然科学基金(CATC2009BB5063)~~
关键词
降钙素原
肝疾病
自发性细菌性腹膜炎
procalcitonin
liver disease
spontaneous bacterial peritonitis
