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肝硬化患者腹水感染与血清降钙素原的相关性分析

ISSN号：1005-4529
期刊名称：《中华医院感染学杂志》
时间：0
分类：R446[医药卫生—诊断学;医药卫生—临床医学]
作者机构：[1]重庆医科大学附属永川医院消化内科,重庆402160, [2]重庆医科大学附属永川医院感染科,重庆402160
相关基金：重庆市卫生局基金资助项目（2012-2-177）

关键词：肝硬化, 血清降钙素原, 腹水感染, 细菌培养, Liver cirrhosis, Serum procalcitonin, Ascites infection, Bacterial culture

中文摘要：

目的探讨肝硬化患者腹水感染与血清降钙素原（PCT）的相关性,为肝硬化腹水感染的诊断提供参考。方法选择2013年4月-2015年4月于医院接受治疗的50例病毒性肝炎肝硬化腹水细菌性腹膜炎患者作为试验组,另选取50例病毒性肝炎腹水未感染患者作为对照组,采集试验组患者腹水样本,予以细菌培养、鉴定及药敏试验,同时检测两组患者血清PCT、多形核白细胞（PMN）、白细胞（WBC）数,观察患者腹水中细菌培养阳性率及血清PCT检测结果分布、各时段PTC浓度变化。结果试验组患者腹水样本共分离出病原菌133株,革兰阳性菌共52株占39.10%,革兰阴性菌65株占48.87%,真菌15株占11.28%,抗酸杆菌1株占0.75%;试验组患者血清中PTC、PMN、WBC检测结果均显著高于对照组,比较差异有统计学意义（P〈0.05）;血清PCT以0.5ng/ml为阳性界值,则血清PCT对腹膜炎诊断敏感度为96.00%,对照组全为阴性。试验组患者随着治疗的介入,腹水感染得到改善,其血清中PCT水平也随之降低,而对照组患者血清中PCT水平则变化不明显。结论肝硬化患者中血清PCT和腹水感染成正相关,且具有较高的敏感性,对肝硬化腹水感染患者的诊断及治疗有着较高的临床参考价值。在对肝硬化腹水感染患者治疗时要合理对抗菌药物进行选择,并及时进行细菌培养和药敏试验。

英文摘要：

OBJECTIVE To investigate the correlation of ascites infection and serum procalcitionin in patients with liver cirrhosis so as to provide reference for diagnosis of ascite infection.METHODSFrom Apr.2013 to Apr.2015,totally 50 viral hepatitis patients with bacterial peritonitis caused by ascites infection were chosen as the experiment group and another 50 viral hepatitis patients without ascites infection were chosen as control group.The ascites samples of the experiment group were collected to cultivate and identify the bacteria and drug sensitivity test was conducted.Serum PCT,PMN and WBC were counted.Bacterial positive rate and serum PCT levels and PTC concentration in different times of the ascites were observed.RESULTSTotally 133 strains of pathogens were isolated from ascites samples of the experiment group,including 52 strains of gram-positive bacteria（39.10%）,65 strains of gram-negative bacteria（48.87%）,15 strains of fungi（11.28%）and 1strain of acid-fast bacillus（0.75%）.Levels of PTC,PMN and WBC of the experiment group in the serum were significantil higher than the control group（P〈0.05）.When serum PCT was higher than 0.5ng/ml,then it can be defined as positive and according to this,the sensitivity of using PCT to diagnose peritonitis was 96.00%.The control group proved to be all negative,With the intervention,ascites infections of the experiment group had improved and PCT level decreased with it.PCT level of the control group did not change significantly.CONCLUSION Serum procalcitonin and ascites infection are positively correlated,and PCT has a high sensitivity for the diagnosis and treatment of ascites due to cirrhosis infected patients with a high clinical reference value.When treating cirrhotic patients with ascites infection,antibiotics should be chosen rationally and bacterial culture and drug sensitivity test should be conducted in time.