發(fā)布時(shí)間：2018-11-10 13:57

【摘要】：目的探討血降鈣素原(procalcitonin,PCT)和中性粒細(xì)胞比例(percentage of neutrophils,Neu%)對(duì)肝病自發(fā)性細(xì)菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的診斷價(jià)值。方法回顧性分析2014年1月至2016年12月在西南醫(yī)院感染科住院且入院后同時(shí)檢測(cè)PCT、血常規(guī)、腹水常規(guī)和腹水培養(yǎng)的130例肝病腹水患者臨床資料,SBP確診組89例,其中培養(yǎng)陽(yáng)性且多形核細(xì)胞(polyremorphonuclear,PMN)≥250×10~6/L患者10例(SBP1組),培養(yǎng)陽(yáng)性但PMN250×10~6/L患者11例(SBP2組),培養(yǎng)陰性但PMN≥250×10~6/L患者68例(SBP3組);非感染性腹水組41例。比較4組患者入院時(shí)的血PCT、Neu%、腹水PMN等指標(biāo)。通過(guò)受試者工作曲線(ROC)評(píng)價(jià)PCT、Neu%對(duì)SBP的診斷價(jià)值及效能。結(jié)果 PMN≥250×10~6/L的SBP患者培養(yǎng)陽(yáng)性率為12.8%。PCT在培養(yǎng)陽(yáng)性的腹水患者中顯著高于培養(yǎng)陰性的患者[中位數(shù)(四分位距)]:[4.51(1.54,8.46)vs 0.77(0.21,1.69),P0.05]。通過(guò)ROC曲線分析,PCT診斷SBP1、SBP2、SBP3的最佳界值分別為:0.795、0.265、0.405 ng/m L;AUC值依次為:0.963、0.767、0.714;敏感度依次為:100.00%、90.00%、62.30%;特異度依次為:92.70%、63.40%、80.50%;血常規(guī)Neu%診斷的最佳界值分別為:68.45%、62.65%、65.00%;AUC值依次為:0.878、0.756、0.669。依據(jù)上述界值,降鈣素原和中性粒細(xì)胞比例兩者串聯(lián)診斷SBP1、SBP2、SBP3的AUC值依次為:0.976、0.865、0.706。結(jié)論血降鈣素原和血常規(guī)中性粒細(xì)胞比例在SBP中均具有一定的預(yù)警效果和診斷價(jià)值,不同類型SBP其CUT-OFF值不同,臨床可根據(jù)實(shí)際情況綜合分析。
[Abstract]:Objective to evaluate the diagnostic value of serum procalcitonin (procalcitonin,PCT) and neutrophil ratio (percentage of neutrophils,Neu%) in the diagnosis of spontaneous bacterial peritonitis (spontaneous bacterial peritonitis,SBP) in liver diseases. Methods the clinical data of 130 patients with liver and ascites from January 2014 to December 2016 were analyzed retrospectively, including PCT, blood routine examination, ascitic fluid routine test and ascites culture. 89 patients were diagnosed as SBP group. Among them, 10 cases (SBP1 group) were cultured positive and polymorphic cells (polyremorphonuclear,PMN) 鈮，

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