血浆PCT NLR及MCP-1指标检测对肝硬化合并细菌性腹膜炎患者的诊断及预后评估价值

doi:10.3969/j.issn.1006-6233.2020.08.016

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摘要 目的: 探讨血浆降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)及单核细胞趋化蛋白-1(MCP-1)指标检测对肝硬化合并细菌性腹膜炎(SBP)患者的诊断及预后评估价值。方法: 选择2017年12月至2018年12月我院收治的肝硬化腹水患者146例。根据临床表现以及实验室检查结果将患者分为SBP组(n=76)与非SBP组(n=70), 另随机选取我院同期健康体检者51例为对照组。检测三组受试者血浆PCT、NLR、MCP-1水平, 绘制受试者特征(ROC)曲线分析PCT、NLR及MCP-1对肝硬化合并SBP的诊断价值, 分析SBP组患者治疗前后血浆PCT、NLR、MCP-1水平变化情况, 探讨PCT、NLR、MCP-1对肝硬化合并SBP预后评估的价值。结果: SBP组血浆PCT、NLR、MCP-1水平明显高于非SBP组、对照组(P<0.05), 非SBP组高于血浆MCP-1水平明显高于对照组(P<0.05), PCT、NLR与对照组比较, 差异无统计学意义(P>0.05);绘制ROC曲线结果显示, PCT取最佳截断值0.94ng/mL时, 诊断肝硬化合并SBP的AUC为0.850(95%CI:0.787-0.912), NLR取最佳截断值13.72时, AUC为0.721(95%CI:0.639-0.803), MCP-1取最佳截断值0.69μg/L时, AUC为0.810(95%CI:0.741-0.879), 三者联合诊断的AUC为0.866(95%CI:0.807-0.926), 联合诊断的AUC、灵敏度、特异度优于PCT、NLR、MCP-1单独诊断;肝硬化合并SBP患者治疗后血浆PCT、NLR、MCP-1水平明显低于治疗前(P<0.05)。结论: 肝硬化合并SBP患者血浆PCT、NLR、MCP-1水平异常升高, 检测血浆PCT、NLR、MCP-1水平对肝硬化合并SBP患者早期诊断以及预后评估有一定临床价值。

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关键词 ：降钙素原, 中性粒细胞与淋巴细胞比值, 单核细胞趋化蛋白-1, 肝硬化, 细菌性腹膜炎, 价值

Abstract：Objective: To investigate the detection of plasma procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR) and monocyte chemotactic protein-1 (MCP-1) in the diagnosis of liver cirrhosis with spontaneous bacterial peritonitis (SBP) and the value of prognosis evaluation. Methods: A total of 146 patients with liver cirrhosis and ascites treated in our hospital from December 2017 to December 2018 were selected and divided into SBP group (n=76) and non-SBP group (n=70) according to clinical manifestations and laboratory examination results. Another 51 healthy examinees in the same period in our hospital were randomly selected as control group. The levels of plasma PCT, NLR and MCP-1 were measured among the three groups, and receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of PCT, NLR and MCP-1 on liver cirrhosis with SBP. The changes of plasma PCT, NLR and MCP-1 before and after treatment were analyzed in SBP group, and the value of PCT, NLR and MCP-1 in the prognosis evaluation of liver cirrhosis with SBP was investigated. Results: The levels of plasma PCT, NLR and MCP-1 in SBP group were significantly higher than those in non-SBP group and control group (P<0.05), and the level of plasma MCP-1 in non-SBP group was significantly higher than that in control group (P<0.05), and there were no significant differences in the PCT and NLR compared with those in control group (P>0.05). ROC curve results showed that when the optimal cutoff value of PCT was 0.94ng/ml, the AUC for diagnosis of liver cirrhosis with SBP was 0.850 (95% CI: 0.787-0.912), and when the optimal cutoff value of NLR was 13.72, the AUC was 0.721 (95% CI: 0.639-0.803), and when the optimal cutoff value of MCP-1 was 0.69μg/L, the AUC was 0.810 (95% CI: 0.741-0.879), and the AUC of combination of the three was 0.866 (95% CI: 0.807-0.926). The AUC, sensitivity and specificity of the combined diagnosis were better than those of PCT, NLR or MCP-1 alone. The levels of plasma PCT, NLR and MCP-1 in patients with liver cirrhosis and SBP after treatment were significantly lower than those before treatment (P<0.05). Conclusion: The levels of plasma PCT, NLR and MCP-1 are abnormally elevated in patients with liver cirrhosis and SBP. Detection of plasma PCT, NLR and MCP-1 has certain clinical value in the early diagnosis and prognosis evaluation of liver cirrhosis and SBP.

Key words： Procalcitonin Neutrophil-to-lymphocyte ratio Monocyte chemotactic protein-1 Liver cirrhosis Spontaneous bacterial peritonitis Value

基金资助:陕西省科学技术研究发展计划项目, (编号:2013K13-01-18)

通讯作者: 刘小静

引用本文:

许娟, 刘小静, 刘小静, 秦丽君. 血浆PCT NLR及MCP-1指标检测对肝硬化合并细菌性腹膜炎患者的诊断及预后评估价值[J]. 河北医学, 2020, 26(8): 1300-1303.
XU juan, LIU xiaojing, QIN Lijun. Detection of Plasma PCT, NLR and MCP-1 in the Diagnosis of Liver Cirrhosis Complicated with Spontaneous Bacterial Peritonitis and the Prognosis Evaluation. HeBei Med, 2020, 26(8): 1300-1303.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.08.016 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I8/1300

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