The significance of serum sCD14 and ascitic lactoferrin in the diagnosis of spontaneous bacterial peritonitis in cirrhosis
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摘要: [目的]研究血清sCD14与腹水乳铁蛋白(LF)在肝硬化自发性细菌性腹膜炎诊治中的意义。[方法]选取我院在2014年3月~2016年7月期间收治的88例肝硬化患者,根据病患者病情将患者分成肝硬化自发性细菌性腹膜炎组(A组=30例)与单纯性腹水肝硬化组(B组=58例),同时另选取44例来我院做常规检查的健康居民作为对照组。抽取患者的血液以及腹水送至实验室进行检查,采用免疫层析法检测腹水乳铁蛋白,采用细胞分流术检测sCD14的表达水平,观察腹水乳铁蛋白与sCD14对肝硬化自发性细菌性腹膜炎患者的诊治意义。[结果]A组患者sCD14、WBC、ALT、AST为[(47.59±11.34)mg/L、(16.75±3.25)×109/L、(156.85±32.61)U/ml、(132.65±23.51)U/ml],显著高于B组与对照组[(3.64±0.57)mg/L、(8.41±1.21)×109/L、(45.26±6.61)U/ml、(36.43±9.62)U/ml,(0.52±0.11)mg/L、(7.45±1.03)×109/L、(37.24±5.14)U/ml、(31.24±5.41)U/ml,(P<0.05)];A组患者LF阳性表达率为(90.00%)、表达水平为(162.52±37.21)ng/ml,显著高于B组[(17.24%)、(76.49±11.24)ng/ml、(P<0.05)];经Spearman等级相关性分析显示,血清sCD14、腹水LF水平随自发性细菌性腹膜炎患者Child-Pugh分级升高而增加[r=0.814、r=0.734,P<0.05]。组间比较,Child-PughC级患者血清sCD14与LF水平最高,Child-PughB级患者血清sCD14与LF水平次之,Child-PughA级患者血清sCD14与LF水平最低,经综合治疗后,A组患者sCD14与LF值为[(4.63±1.02)mg/L、(35.62±11.02)ng/ml],显著低于治疗前[(47.59±11.34)mg/L、(162.52±37.21)ng/ml,(P<0.05)],B组患者治疗后sCD14与LF值为[(0.51±0.12)mg/L、(33.02±10.34)ng/ml],显著低于治疗前[(0.76±0.21)mg/L、(76.49±11.24)ng/ml,(P<0.05)]。[结论]血清sCD14与腹水LF在肝硬化自发性细菌性腹膜炎的早期诊断中具有重要的临床意义,对自发性细菌性腹膜炎与无菌性腹膜炎具有鉴别诊断意义,并且还能用于预测Child-Pugh的分级,为临床上疾病评估提供相应的参考依据。Abstract: [Objective]To investigate the significance of serum sCD14 and ascitic lactoferrin(LF)in the diagnosis of spontaneous bacterial peritonitis in cirrhosis.[Methods]A total of 88 cases of liver cirrhosis in our hospital during the period from March 2014 to July 2016 were selected.According to the condition of patients,they were divided into cirrhosis and spontaneous bacterial peritonitis group(A group with 30 cases)and simple ascites cirrhosis group(B group with 58 cases),and the other 44 health residents in our hospital underwent the routine examination were selected as the control group.The blood and ascites were collected and sent to the lab for inspection.The level of ascites lactoferrin was detected by Immunochromatography and the expression level of sCD14 were detected by cell shunt.The diagnosis and treatment significance of lactoferrin and sCD14 in liver cirrhosis spontaneous bacterial peritonitis were observed.[Results]The level of sCD14,WBC,ALT,AST in A groups was[(47.59±11.34)mg/L,(16.75±3.25)×109/L,(156.85±32.61)U/ml,(132.65±23.51)U/ml],which were significantly higher than that of B group and control group[(3.64±0.57)mg/L,(8.41±1.21)×109/L,(45.26±6.61)U/ml,(36.43±9.62)U/ml,(0.52±0.11)mg/L,(7.45±1.03)×109/L,(37.24±5.14)U/ml,(31.24±5.41)U/ml,(P<0.05)].The LF positive expression rate of A group was 90.00% and the expression level was(162.52±37.21)ng/ml,which were significantly higher than that of B group[(17.24%),(76.49±11.24)ng/ml,(P<0.05)].The Spearman rank correlation analysis showed that serum sCD14 and LF levels increased with ascites of spontaneous bacterial peritonitis in patients with Child-Pugh grade and increase[r=0.814,r=0.734,P<0.05].The serum sCD14 and LF levels in patients with Child-Pugh C level were highest,the serum levels in patients with Child-Pugh B were the second level and the serum level in Child-Pugh A was the lowest.After comprehensive treatment,the sCD14 and LF value of the A group was[(4.63±1.02)mg/L,(35.62±11.02)ng/ml],which were significantly lower than that before treatment[(47.59±11.34)mg/L,(162.52±37.21)ng/ml,(P<0.05)].The sCD14 and LF value of patients after treatment were[(0.51 ±0.12)mg/L,(33.02±10.34)ng/ml],which were significantly lower than that before treatment[(0.76±0.21)mg/L,(76.49±11.24)ng/ml,(P<0.05)].[Conclusion]It has important clinical significance in early diagnosis of liver cirrhosis spontaneous bacterial peritonitis of serum sCD14 and ascites LF with differential diagnosis of spontaneous bacterial peritonitis and aseptic peritonitis,which can also be used to predict Child-Pugh grading.It provide the corresponding reference for clinical disease assessment.
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Key words:
- Serum sCD14 /
- Ascites lactoferrin /
- Cirrhosis /
- Spontaneous bacterial peritonitis
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