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目的探讨脂多糖结合蛋白(LBP)、肿瘤坏死因子-α(TNF-α)和降钙素原(PCT)在自发性细菌性腹膜炎(SBP)患者中的应用价值。方法选取本院112例肝硬化腹水患者,按有无自发性细菌性腹膜炎分为两组,其中并发自发性细菌性腹膜炎患者72例,无自发性细菌性腹膜炎患者40例。采用酶联免疫吸附法(ELISA)检测LBP和TNF-α水平,采用免疫化学发光法(ILMA)测定PCT水平,并将各组结果进行比较分析。结果 SBP组患者腹水中LBP、TNF-α和PCT 3项浓度显著高于非SBP组患者腹水中的浓度(P<0.05);SBP组中治疗有效患者急性期LBP、TNF-α和PCT浓度显著高于其恢复期水平,感染控制后3项浓度显著下降(P<0.05);SBP组中死亡组LBP、TNF-α和PCT浓度显著高于存活组中的浓度(P<0.05)。结论失代偿肝硬化并发SBP时,腹水中LBP、TNF-α和PCT均有较高的表达,并与疾病严重程度及预后密切相关。LBP、TNF-α和PCT浓度的变化对自发性细菌性腹膜炎早期诊断、疗效观察和判断预后有一定的临床价值。
Objective To investigate the value of lipopolysaccharide binding protein (LBP), tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) in patients with spontaneous bacterial peritonitis (SBP). Methods A total of 112 patients with cirrhosis and ascites were randomly divided into two groups according to the presence or absence of spontaneous bacterial peritonitis, including 72 patients with spontaneous bacterial peritonitis and 40 patients without spontaneous bacterial peritonitis. The levels of LBP and TNF-α were detected by enzyme-linked immunosorbent assay (ELISA). The level of PCT was measured by immunochemiluminescence (ILMA). The results of each group were compared. Results The concentrations of LBP, TNF-α and PCT in ascites of SBP group were significantly higher than those in non-SBP group (P <0.05). The levels of LBP, TNF-α and PCT in acute phase of SBP group were significant (P <0.05). The concentrations of LBP, TNF-α and PCT in the death group were significantly higher than those in the survival group (P <0.05). Conclusions In patients with decompensated cirrhosis complicated with SBP, the expression of LBP, TNF-α and PCT are higher in ascites and is closely related to the severity and prognosis of the disease. The changes of the concentration of LBP, TNF-α and PCT have some clinical value for the early diagnosis of spontaneous bacterial peritonitis, the observation of curative effect and prognosis.