Pathophysiology Department, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Liver Int. 2009 Nov;29(10):1538-42. doi: 10.1111/j.1478-3231.2009.02088.x. Epub 2009 Jul 31.
Cirrhosis is associated with elevated levels of acute-phase proteins (APP), irrespective of the presence of infection. This condition limits the clinical application of APP determination in cirrhotic patients with bacterial infections.
To weigh the diagnostic value of several APP in cirrhotics with or without bacterial infection, and to correlate them with the clinical outcome.
We investigated 88 consecutive cirrhotic patients (67 males, 21 females; range 28-85 years) with mean age (SD) 58.9 (13.8) on admission, according to a standard protocol for infection. We measured the following APP: C-reactive protein (CRP), fibrinogen (FIB), haptoglobin (Hpt), ferritin (Fer), beta2-microglobulin (beta2-mg), C3, C4 and C1 inhibitor.
From the 88 patients, 19 (21.6%) had documented infection at the entry based on clinical, radiological and microbiological data. This group of patients did not differ in basic demographics from those without infection. CRP [17.5 (20.7) vs 77.1 (43.9), P<0.001], beta2-mg [4.4 (4.1) vs 5.6 (2.2), P<0.001] and ferritin [461.2 (776.4) vs 825.8 (870), P=0.03] were significantly higher in infection, whereas C3 was significantly lower. No significant differences were noted in the remaining APP levels between the two groups. After receiver operating characteristic curves were fitted, CRP was the best diagnostic test for infection (area under the curve 0.91), followed by beta2-mg, ferritin, FIB, C1 inhibitor, C4, Hpt and C3.
Serum CRP is the best test, among the examined APP, to discriminate bacterial infection in cirrhotics. A cut-off value of >55.8 mg/L has high sensitivity (79%) and specificity (96%), with the best diagnostic accuracy (92%).
无论是否存在感染，肝硬化都会导致急性期蛋白（APP）水平升高。这种情况限制了 APP 测定在肝硬化合并细菌感染患者中的临床应用。
评估几种 APP 在肝硬化伴或不伴细菌感染患者中的诊断价值，并与临床结局相关联。
我们按照感染标准方案，对 88 例连续的肝硬化患者（67 名男性，21 名女性；年龄 28-85 岁，平均年龄 58.9±13.8 岁）进行了调查。我们测量了以下 APP：C 反应蛋白（CRP）、纤维蛋白原（FIB）、触珠蛋白（Hpt）、铁蛋白（Fer）、β2-微球蛋白（β2-mg）、C3、C4 和 C1 抑制剂。
根据临床、影像学和微生物学数据，88 例患者中有 19 例（21.6%）确诊为感染。与无感染的患者相比，该组患者在基本人口统计学特征方面无差异。CRP [17.5（20.7）比 77.1（43.9），P<0.001]、β2-mg [4.4（4.1）比 5.6（2.2），P<0.001]和铁蛋白 [461.2（776.4）比 825.8（870），P=0.03] 在感染组中显著升高，而 C3 显著降低。两组之间其余 APP 水平无显著差异。拟合受试者工作特征曲线后，CRP 是感染的最佳诊断试验（曲线下面积 0.91），其次是β2-mg、铁蛋白、FIB、C1 抑制剂、C4、Hpt 和 C3。
在检测的 APP 中，血清 CRP 是区分肝硬化细菌感染的最佳检测指标。截断值>55.8mg/L 具有高灵敏度（79%）和特异性（96%），诊断准确性最佳（92%）。
