人中性粒细胞肽在自发性细菌性腹膜炎中的诊断价值

[Diagnostic value of human neutrophil peptide in spontaneous bacterial peritonitis].

作者信息

Gong Yan-xue, Cui Su-nan, Li Li, Wang Ming-ming, Guo Nan

机构信息

School of Medicine, Shandong University, Jinan 250012, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2013 Dec;21(12):944-8. doi: 10.3760/cma.j.issn.1007-3418.2013.12.014.

DOI:10.3760/cma.j.issn.1007-3418.2013.12.014

PMID:24636299

Abstract

OBJECTIVE

To investigate the correlation between human neutrophil peptide (HNP) and spontaneous bacterial peritonitis (SBP) in order to assess the diagnostic value of quantitative measurement of these alpha-defensins.

METHODS

Seventy-seven patients with cirrhosis and ascites were divided into two groups according to diagnosis of SBP (n = 45 with SBP and n = 32 without SBP). Twenty-eight healthy individuals were analyzed as controls. HNP was detected by double-antibody sandwich assay. Peripheral white blood cell (WBC) counts, neutrophil ratio, and levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined by standard methods. Receiver operating characteristic (ROC) curves were used to compare the diagnostic values of HNP, PCT and CRP in SBP.

RESULTS

There were no significant differences between the three groups (SBP, non-SBP, and healthy controls) for WBC count ((6.01+/-2.25)*109 /L, (4.85+/-1.94)*109 /L, and (5.49+/-1.76)*109 /L; F = 2.91, P more than 0.05) and neutrophil ratio (70.70%+/-10.42%, (68.20%+/-8.97%, and 69.50%+/-8.69%; F = 3.07, P more than 0.05). However, compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher levels of HNP ((9.99+/-3.33) ng/ml and (8.92+/-2.30) ng/ml vs. (17.66+/-6.40) ng/ml; q = 3.20 vs. 3.52, P less than 0.05), serum CRP ((15.08+/-9.95) ng/ml and (5.96+/-2.91) ng/ml vs. (31.32+/-18.65) mg/L; q = 11.03 vs. 3.69, P less than 0.05), and positive rate of PCT (25.0% and 10.0% vs. 62.2%; X2 = 10.41 vs. 15.40, P less than 0.0125). The areas under the curve (AUC) showed the following descending trend: HNP more than PCT more than CRP (0.719, 0.707, and 0.629 respectively). Using cut-off points of 10 ng/ml for HNP, 0.5 ng/ml for PCT, and 8 mg/L for CRP, the respective sensitivities for diagnosis of SBP were 71.1%, 62.2%, and 73.3%, the respective specificities were 71.9%, 75.0%, and 56.3%, and the respective Youden's indexes were 0.430, 0.372, and 0.296.

CONCLUSION

HNP is closely related to SBP and can diagnose SBP as reliably as PCT. CRP may help to diagnose SBP, but the results from routine blood testing did not show sufficient statistical significance for diagnosing SBP.

摘要

目的

研究人中性粒细胞肽（HNP）与自发性细菌性腹膜炎（SBP）之间的相关性，以评估这些α-防御素定量检测的诊断价值。

方法

77例肝硬化腹水患者根据SBP诊断分为两组（45例SBP患者和32例非SBP患者）。28名健康个体作为对照进行分析。采用双抗体夹心测定法检测HNP。采用标准方法测定外周血白细胞（WBC）计数、中性粒细胞比例、降钙素原（PCT）水平和C反应蛋白（CRP）水平。采用受试者工作特征（ROC）曲线比较HNP、PCT和CRP在SBP中的诊断价值。

结果

三组（SBP组、非SBP组和健康对照组）的WBC计数（（6.01±2.25）×10⁹/L、（4.85±1.94）×10⁹/L和（5.49±1.76）×10⁹/L；F = 2.91，P＞0.05）和中性粒细胞比例（70.70%±10.42%、（68.20%±8.97%和69.50%±8.69%；F = 3.07，P＞0.05）无显著差异。然而，与非SBP组和健康对照组相比，SBP组的HNP水平显著更高（（9.99±3.33）ng/ml和（8.92±2.30）ng/ml vs（17.66±6.40）ng/ml；q = 3.20 vs 3.52，P＜0.05）、血清CRP（（15.08±9.95）ng/ml和（5.96±2.91）ng/ml vs（31.32±18.65）mg/L；q = 11.03 vs 3.69，P＜0.05）以及PCT阳性率（25.0%和10.0% vs 62.2%；X² = 10.41 vs 15.40，P＜0.0125）。曲线下面积（AUC）呈以下下降趋势：HNP＞PCT＞CRP（分别为0.719、0.707和0.629）。以HNP 10 ng/ml、PCT 0.5 ng/ml和CRP 8 mg/L为截断点，诊断SBP的敏感性分别为71.1%、62.2%和73.3%，特异性分别为71.9%、75.0%和56.3%，约登指数分别为0.430、0.372和0.296。