腹水降钙素原、C反应蛋白对自发性细菌性腹膜炎患者早期治疗的指导价值
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The guiding value of procalcitonin and C⁃reactive protein in ascites for early treatment of spontaneous bacterial peritonitis patients
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    摘要:

    目的:研究降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)在疑似腹腔感染的肝硬化患者早期治疗中的应用价值。方法:收集腹水细胞计数结果符合自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)诊断标准的肝硬化患者128例,留取腹水检测PCT和CRP,并根据腹水培养结果分为SBP组和非SBP组。分析PCT、CRP和SPB发生的关系。 比较PCT、CRP在感染革兰氏阴性菌(G-)和革兰氏阳性菌(G+)患者中的差异。通过绘制ROC曲线分析PCT、CRP对SBP的最优诊断阈值(cut-off值)。利用PCT、CRP的cut-off值作为治疗用药标准,重新将128例患者分组,分析使用抗生素治疗的准确率。结果:非SBP组腹水PCT水平低于SBP组(P < 0.05),CRP水平差异无统计学意义(P > 0.05)。SBP患者中G-组PCT显著高于G+组(P < 0.05),CRP差异无统计学意义(P > 0.05)。PCT ROC曲线下面积为0.670,cut-off值为0.290 ng/mL。CRP ROC曲线下面积为0.684,cut-off值为34.0 mg/L。不使用炎症指标、以PCT>0.290 ng/mL为标准和以CRP>34.0 mg/L为标准3种情况下,使用抗生素治疗的准确率分别为67.2%、88.6%和81.6%。结论:PCT、CRP能为肝硬化患者SBP的早期筛查和治疗提供依据,提高抗生素治疗的准确率。

    Abstract:

    Objective:This study aims to investigate the value of procalcitonin(PCT) and C-reactive protein(CRP) in the early treatment of cirrhosis patients with suspected abdominal infection. Methods:One hundred and twenty eight cirrhotic patients whose ascites cell count results meet the diagnostic criteria of spontaneous bacterial peritonitis(SBP) were enrolled in this study. PCT and CRP in ascitic specimens were tested,and patients were divided into SBP group and non-SBP group according to the bacterial culture results of ascitic specimens. The correlation between PCT,CRP expression and the occurrence of SBP were analyzed;the difference of PCT and CRP expression in patients infected with gram-negative bacteria(G-) and gram-positive bacteria(G+)were compared. The ROC curve was used to find the cut-off value of PCT and CRP level in SBP diagnosis. According to cut-off values of PCT and CRP used as the treatment standard,128 patients were re-grouped and the accuracy of antibiotic treatment was analyzed. Results:PCT level was much lower in non-SBP group than in SBP group(P < 0.05),and there was no statistical difference in CRP level between non-SBP group and SBP group(P > 0.05). PCT level were higher in G- group than in G+ group(P < 0.05),and there was no statistical difference in CRP level between G- group and G+ group(P > 0.05). The area under the ROC curve of PCT and ROC were 0.670 and 0.684,the cut-off value were 0.290 ng/mL and 34.0 mg/L,respectively. Under the situation without inflammatory biomarkers supplied,with PCT>0.290 ng/mL and with CRP>34.0 mg/L,the accuracy of antibiotic therapy were 67.2%,88.6% and 81.6%,respectively. Conclusion:PCT and CRP detection can provide useful information for screening and diagnosing SBP in cirrhosis patients,and elevate the accuracy of antibiotic therapy.

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吉远辉,许红攀,宁明哲.腹水降钙素原、C反应蛋白对自发性细菌性腹膜炎患者早期治疗的指导价值[J].南京医科大学学报(自然科学版),2019,(9):1323-1326

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  • 收稿日期:2018-12-30
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  • 在线发布日期: 2019-09-29
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