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降钙素原和外周血白细胞/血小板单独或联合检测对肝硬化合并细菌感染患者早期诊断的价值
Value of single or combined measurement of serum PCT, peripheral WBC, and WBC/PCT for early diagnosis of bacterial infection in patients with liver cirrhosis
文章发布日期:2015年02月13日  来源:  作者:郑俊福, 蔡照华, 张鑫,等  点击次数:2566次  下载次数:614次

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【摘要】:目的探讨血清降钙素原(PCT)、外周血白细胞(WBC)、WBC/血小板(PLT)单独及联合检测对肝硬化患者合并自发性腹膜炎(SBP)早期诊断的价值。方法回顾性分析2011年1月-2013年6月首都医科大学附属北京佑安医院收治的129例肝硬化患者,包括肝硬化死亡患者112例,其中并发感染导致死亡患者94例(感染组),包括SBP 61例;其他原因导致死亡18例(非感染组),肝硬化代偿期患者17例为对照组。使用抗生素前常规细菌培养,并测定血清PCT及WBC、WBC/PLT。计量资料比较采用t检验和方差分析,率比较应用χ2检验,利用受试者工作特征曲线(ROC曲线)计算其敏感性、特异性。结果在94例肝硬化合并感染的患者中,细菌培养阳性66例,其中血、腹水及其他分泌物培养阳性率分别为25.8%、30.3%及43.9%。肺部感染占8.5%,SBP 为64.9%,感染灶不明确占26.6%。感染组患者血清PCT明显高于非感染组及对照组(F=10.98,P<0.05)。不同感染部位患者血清PCT差异无统计学意义(P>005)。PCT≥0.5 ng/ml,肝硬化合并感染的敏感性为92.5%,特异性为77.1%,ROC曲线下面积为0.89。PCT≥2 ng/ml,其敏感性为62.8%,特异性为94.2%。外周血WBC≥10×109/L及WBC/PLT≥0.25时,肝硬化合并感染的敏感性分别为47.8%,39.6%,特异性为100%。PCT联合WBC/PLT,其敏感性为76.8%,特异性为94.2%。SBP患者腹水培养阳性与否,PCT、WBC、WBC/PLT差异无统计学意义;PCT联合WBC/PLT,诊断SBP的敏感性为83.6%,特异性为94.2%。结论PCT、WBC/PLT可作为肝硬化合并感染的诊断指标,PCT与WBC/PLT联合对肝硬化SBP的早期诊断具有重要价值。
【Abstract】:ObjectiveTo investigate the early diagnostic value of single or combined measurement of serum procalcitonin (PCT), peripheral white blood cells (WBC), and ratio of WBC to platelets (PLT) (WBC/PLT) for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. MethodsThe clinical data of 129 patients with liver cirrhosis who were admitted to our hospital from January 2011 to June 2013 were retrospectively analyzed. One hundred and twelve patients who died of liver cirrhosis were divided into infection group, in which the cause of death was complicated infection (n=94, including 61 SBP cases), and non-infection group (n=18). Seventeen patients with compensated cirrhosis were assigned to control group. Before treatment with antibiotics, routine bacterial culture was made, and serum PCT, WBC, and WBC/PLT were measured. Mean comparison was made by t test and chi-square analysis. Ratio comparison was made by Pearson χ2 test. The receiver operating characteristic (ROC) curve was plotted to calculate the sensitivity and specificity. ResultsThere were 66 patients in the infection group whose bacterial culture was positive, and the positive rates for cultures from blood, ascites and other exudates were 25.8%, 30.3%, and 43.9%, respectively. In the infection group, lung infection, SBP, and unknown focus of infection accounted for 8.5%, 64.9%, and 26.6% of total cases, respectively. The level of serum PCT in the infection group was significantly higher than those in the non-infection group and the control group (F=10.98, P<0.05), but showed no significant difference in patients with different sites of infection. When PCT was ≥0.5 ng/ml, the sensitivity and specificity for diagnosis of complicated infection were 92.5% and 77.1%, respectively, and the area under the ROC curve was 0.89. When PCT was ≥2 ng/ml, the sensitivity was 62.7% and the specificity was 94.2%. When the peripheral WBC count was ≥10×109/L and the WBC/PLT was ≥0.25, the sensitivity was 47.8% and 396%, respectively, and the specificity was 100%. When PCT was combined with WBC/PLT for diagnosis of complicated infection, the sensitivity was 76.8% and the specificity was 94.2%. For patients with SBP, the levels of PCT and WBC and WBC/PLT showed no significant differences between positive and negative ascites cultures. When PCT was combined with WBC/PLT for diagnosis of SBP, the sensitivity was 83.6% and the specificity was 94.2%. ConclusionPCT and WBC/PLT can be used as early diagnostic indicators for complicated infection in cirrhotic patients. PCT combined with WBC/PLT has a significant value for early diagnosis of SBP in cirrhotic patients.
【关键字】:肝硬化;感染;腹膜炎;降钙素原;白细胞;血小板;诊断
【Key words】:liver cirrhosis; infection; peritonitis; procalcitonin; leukocytes; platelets; diagnosis
【引证本文】:

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