腹水中肝素结合蛋白及降钙素原对肝硬化腹水伴自发性细菌性腹膜炎的诊断价值

杨丽霞; 张伦理; 赖玲玲; 方铭

doi:10.3969/j.issn.1001-5256.2019.06.017

腹水中肝素结合蛋白及降钙素原对肝硬化腹水伴自发性细菌性腹膜炎的诊断价值

DOI: 10.3969/j.issn.1001-5256.2019.06.017

1. 南昌大学第一附属医院感染科
2. 南昌大学第一附属医院急诊科

基金项目:

江西省教育厅科学研究项目(GJJ14017);江西省教育厅科学研究项目(GJJ14015)；江西省科技厅人才资助计划(20161BCD40015)；

详细信息

中图分类号: R575.2;R572.2
计量
- 文章访问数: 1485
- HTML全文浏览量: 50
- PDF下载量: 280
- 被引次数: 0
出版历程
- 收稿日期: 2018-12-27
- 出版日期: 2019-06-20

Value of heparin-binding protein in ascites and serum procalcitonin in diagnosis of spontaneous bacterial peritonitis

Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University

Research funding:

摘要

摘要: 目的探讨腹水中的肝素结合蛋白（HBP）联合血清降钙素原（PCT）对自发性细菌性腹膜炎（SBP）的诊断价值。方法收集南昌大学第一附属医院2016年1月-2018年6月住院的腹水患者120例,分为肝硬化腹水伴SBP组（40例）、漏出性腹水组（40例）、癌性腹水组（20例）和结核性腹水组（20例）,纳入患者全部进行腹水培养,测定并统计分析腹水多形核白细胞、腹水HBP和血清PCT水平。符合正态分布的计量资料两组间比较采用独立样本t检验;非正态分布数据多组间比较用Kruskal-Wallis H检验,组间两两比较用Nemenyi检验;腹水HBP、血清PCT诊断效能分析采用受试者工作特征（ROC）曲线分析,腹水HBP、血清PCT相关性采用Spearman分析。结果肝硬化腹水伴SBP组腹水HBP浓度及血清PCT浓度与其余3组（漏出性腹水组、癌性腹水组、结核性腹水组）比较均显著升高（P值均<0. 05）。腹水细菌培养病原学阳性的不同菌种间腹水HBP水平无差异,腹水细菌培养阳性与阴性患者的HBP水平差异无统计学意义[（58. 59±36. 23） ng/ml vs （63. 61±32. 54） ...
- 肝硬化 /
- 自发性细菌性腹膜炎 /
- 腹水 /
- 肝素结合蛋白 /
- 降钙素原
Abstract: Objective To investigate the value of heparin-binding protein (HBP) in ascites combined with serum procalcitonin (PCT) in the diagnosis of spontaneous bacterial peritonitis (SBP) . Methods A total of 120 patients with ascites who were hospitalized in our hospital from January 2016 to June 2018 were enrolled and divided into cirrhotic ascites + SBP group with 40 patients, leaky ascites group with 40 patients, malignant ascites group with 20 patients, and tuberculous ascites group with 20 patients. Bacterial culture of ascites was performed for all patients, and polymorphonuclear leukocyte (PMN) count in ascites, HBP in ascites, and serum PCT level were measured and analyzed.The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between multiple groups; non-normally distributed continuous data were expressed as median [M (P25, P75) ], and the Kruskal-Wallis H test was used for comparison between multiple groups and the Nemenyi test was used for comparison between two groups. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of HBP in ascites and serum PCT, and the Spearman correlation analysis was used to investigate the correlation between HBP in ascites and serum PCT. Results The cirrhotic ascites + SBP group had significant increases in the levels of HBP in ascites and serum PCT compared with the leaky ascites group, the malignant ascites group, and the tuberculous ascites group (P < 0. 05) . There was no significant difference in HBP level in ascites between patients with different bacteria determined by bacterial culture of ascites (P > 0. 05) , and there was also no significant difference in HBP level in ascites between patients with positive or negative results of bacterial culture of ascites (58. 59 ± 36. 23 ng/ml vs 63. 61 ±32. 54 ng/ml, t = 1. 763, P > 0. 05) . Serum PCT had an optimal cut-off value of 0. 62 ng/ml in the diagnosis of SBP, with an area under the ROC curve of 0. 831, a sensitivity of 86. 3%, and a specificity of 52. 8%. HBP in ascites had an optimal cut-off value of 23. 54 ng/ml in the diagnosis of SBP, with an area under the ROC curve of 0. 962, a sensitivity of 92. 3%, and a specificity of 65. 4%. Ascites HBP was highly correlated with serum PCT (r = 0. 776, P < 0. 05) . Conclusion The level of HBP in ascites has a high value in the diagnosis of SBP, and combined measurement of ascites HBP and serum PCT can improve the diagnostic efficiency of SBP.
- liver cirrhosis /
- spontaneous bacterial peritonitis /
- ascites /
- heparin binding protein /
- procalcitonin

HTML全文

参考文献(16)

[1]TVERRING J, VAARA SUVI T, FISHER J, et al.Heparin-binding protein (HBP) improves prediction of sepsis-related acute kidney injury[J].Ann Intensive Care, 2017, 7 (1) :105.

[2]KIM JJ, TSUKAMOTO MM, MATHUR AK, et al.Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis[J].Am J Gastroenterol, 2014, 109 (9) :1436-1442.

[3]MEHRNAZ AG, SEYED FA, HOSSEIN F, et al.Blood Procalcitonin predicts spontaneous bacterial peritonitis in patients with cirrhosis and ascites[J].Middle East J Dig Dis, 2015, 7:189-190.

[4]McLAUGHLIN D, SHELLENBACK L.Sepsis in patients with cirrhosis[J].AACN Adv Crit Care, 2016, 27 (4) :408-419.

[5]RHODES A, EVANS LE, ALHAZZANI W, et al.Surviving sepsis campaign:International guidelines for management of sepsis and septic shock:2016[J].Intensive Care Med, 2017, 43 (3) :304-377.

[6]European Association for the Study of Liver.EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J].JHepatol, 2010, 53 (3) :397-417.

[7]GOMEZ-CERQUERA JM, DAROCA-PREZ R, BAEZA-TRINIDAD R, et al.Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients[J].Enferm Infecc Microbiol Clin, 2015, 33 (8) :521-524.

[8]YU W, CHENG YF, ZHANG R.Changes and significance of BNP, NT-proBNP, PCT, NT-proBNP/BNP ratio in elderly patients with heart failure complicated with pulmonary infection[J].Sichuan Med J, 2017, 38 (11) :1314-1317. (in Chinese) 余微, 程幼夫, 张汝.老年心力衰竭合并肺部感染患者BNP、NT-proBNP、PCT、NT-proBNP/BNP比值水平变化及意义[J].四川医学, 2017, 38 (11) :1314-1317.

[9]WANG CM, MENG ZJ, CHEN Y, et al.Value of serum PCT in early diagnosis of bacterial infection in patients with liver failure[J].J Clin Hepatol, 2017, 33 (6) :1137-1138. (in Chinese) 王传敏, 孟忠吉, 陈悦, 等.血清降钙素原检测对肝衰竭合并感染的早期诊断价值[J].临床肝胆病杂志, 2017, 33 (6) :1137-1138.

[10]LIU F, LONG WD, ZHU GM, et al.The values of PCT and CRP in the diagnosis and prognosis of spontaneous bacterial peritonitis in patients with advanced liver disease[J].Chin J Gastroenterol Hepatol, 2017, 26 (9) :1030-1032. (in Chinese) 刘锋, 隆维东, 朱艮苗, 等.PCT及CRP对晚期肝病自发性细菌性腹膜炎患者的诊断及预后价值分析[J].胃肠病学和肝病学杂志, 2017, 26 (9) :1030-1032.

[11]FISHER J, LINDER A.Heparin-binding protein:A key player in the pathophysiology of organ dysfunction in sepsis[J].J Intern Med, 2017, 281 (6) :562-574.

[12]ZHU L, OLSEN RJ, RANDALL J, et al.Contribution of secreted NADase and streptolysin O to the pathogenesis of epidemic serotype M1 streptococcus pyogenes infections[J].Am JPathol, 2017, 187 (3) :605-613.

[13]SNALL J, LINNER A, UHLMANN J, et al.Differential neutrophil responses to bacterial stimuli:Streptococcal strains are potent inducers of heparin-binding protein and resistin-release[J].Sci Rep, 2016, 6:21288.

[14]KASUS-JACOBI A, NOOR-MOHAMMADI S, GRIFFITH G, et al.A multifunctional peptide based on the neutrophil immune defense molecule, CAP37 has antibacterial and woundhealing properties[J].J Leukoc Biol, 2015, 97 (2) :341-350.

[15]LINDER A, KESSON P, INGHAMMAR M, et al.Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock[J].Crit Care, 2012, 16 (3) :90.

[16]LINDER A, RYAN A, JOHN B, et al.Heparin-binding protein measurement improves the prediction of severe infection with organ dysfunction in the emergency department[J].Crit Care Med, 2015, 43 (11) :2378-2386.

施引文献

资源附件(0)

访问统计