| Background and ObjectiveSpontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites is the most common complication, Patients with decompensated cirrhosis are almost associated with reduced hepatic synthesis function, that Resulted in albumin reduction, There are a lot of liver cells was damaged in decompensated cirrhosis. liver detoxification is reduced. At the same time, portal hypertension resulting in intestinal and splenic congestion, the intestinal mucosal barrier was destroyed, the Intestinal vascular permeability was increased, Intestinal motility was disordered and with Immunocompromised,.Intestinal flora, the excessive proliferation of pathogenic bacteria and colonization group transfer are important reasons of SBP. SBP can exacerbate disease progression, if not controlled in time may be rapidly develop into septic shock and liver and kidney failure, induced hepatic encephalopathy, seriously endanger the patient’s life. Therefore, timely and accurate to diagnosis SBP in patients with cirrhosis and ascites treatment is crucial.Currently, the way of diagnosis of SBP mainly in ascites and ascites culture as a standard routine. with blood routine as an important reference index.However, However, affected by many factors, such as by ascites diluted, peritonitis disease response capability, ascites and blood routine in many cases does not fully reflect the true infection status abdominal, also ascites culture takes a long time, the positive rate is low, the diagnosis has certain limitated, So we designed this experiment to observe the plasma of human neutrophil defensin (human neutrophil peptides, HNP) level, and with the blood routine, procalcitonin (PCT) and C-reactive protein (CRP) as a controlto in order to evaluate the diagnostic value of the HNP in SBP. Methods1. The subjects were from July2011to June2012in Jinan Infectious Disease Hospital affiliated to Shandong University of hospitalization in patients with cirrhosis and ascites total of77cases, Of which67cases of hepatitis B, hepatitis C in8cases,2cases of alcoholic liver disease, SBP group of45cases, including32males and13females, their ages range from34to67years, with an average of39.3±15.7years, Non-SBP group were32case,21were male and11were female. Their ages range from32to63years, with an average of35.7±14.9years. Both groups’differences were not statistically significant in sex, age, and etiology, Control group of28case including16males and12females,, aged37～59years old, with an average of47.5±10.6years. SBP diagnostic criteria:(1) varying degrees of fever, abdominal pain, abdominal tenderness and rebound tenderness and other signs of peritoneal irritation and infection,(2) ascites routine:ascites neutrophils>0.25×109/L;(3) ascites culture was positive, To meet (1),(3), or (2) and except tuberculosis, secondary peritonitis and tumors, can diagnose as SBP. While collecting healthy people as a healthy control group.2.outcome measures and Experimental methods,The main outcome measure was plasma HNP, against indicators of peripheral leukocytes (WBC), neutrophil ratio, and plasma PCT and CRP, The diagnosis of SBP the day or the next day, we collected peripheral blood as specimens, Blood routine and neutrophil ratio using automatic blood cell analyzer, EDTA anticoagulated blood vacuum tube2ml timely submission after mixing, PCT, CRP, HNP were collected using heparin as an anticoagulant, mix for20minutes,2000rpm/20minutes centrifugation, the supernatant, the samples stored at-20℃unified assembly of the test specimen upon. HNP using ELISA assay, kit was purchased from Shanghai Hui Jia company; PCT detected by semi-quantitative rapid detection kit (purchased from Germany Brahms company), Divided into four grades,<0.5ng/ml,0.5-2.0ng/ml,2.0-10ng/ml and>10ng/ml,>0.5ng/ml as positive threshold value CRP was detected by chemiluminescence immunoassay instrument was purchased from Bayer.3. Statistical analysis methods Using SPSS18.0statistical software to do univariate analysis; measurement data as mean±standard deviation (χ±s), while using one-way ANOVA and q test; count data using χ2test, multiple pairwise comparisons between experimental groups using χ2segmentation method. Compare the diagnostic value of the several indicators method using receiver operating characteristic (ROC) area under the curve (AUC).AUC used Z-test. When the AUC>0.9, the high diagnostic accuracy, when AUC between0.7and0.9, moderate diagnostic accuracy, when AUC between0.5and0.7is low diagnostic accuracy, when AUC<0.5, no diagnostic value,According to the ROC curve to determine the optimal diagnostic threshold, and determine the sensitivity and specificity of the threshold, calculate Youden index. P<0.05considered statistically significant difference.Results1. 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>0.05) and neutrophil ratio (70.70%±10.42%,(68.20%±8.97%, and69.50%±8.69%; F=3.07, P>0.05).2. 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=3.20vs.3.52, P<0.05).3. There were higher significant differences between the three groups (SBP, non-SBP, and healthy controls) for serum CRP((31.32±18.65) mg/L and ((15.08±9.95) ng/ml vs.(5.96±2.91) ng/ml. F=33.02, P<0.05),SBP group and non-SBP group compare to the healthy controls show higher significant differences (q=11.03vs.3.69, P<0.05)4. compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher positive rate of PCT ((25.0%and10.0%vs.62.2%; χ2=10.41vs.15.40, P<0.0125)5. The areas under the curve (AUC) showed the following descending trend:HNP> PCT> CRP (0.719,0.707, and0.629respectively). Using cut-off points of10ng/ml for HNP,0.5ng/ml for PCT, and8mg/L for CRP, the respective sensitivities for diagnosis of SBP were71.1%,62.2%, and73.3%, the respective specificities were71.9%,75.0%, and56.3%, and the respective Youden’s indexes were0.430,0.372, and0.296.Conclusion1. Plasma HNP have higher sensitivity(71.7%) and Specificity(71.7%) to the diagnosis of SBP, help in the early diagnosis of SBP2. WBC count and neutrophil ratio show low diagnostic value for SBP with Cirrhosis3. Plasma CRP have high sensitivity (73.3%), but the specific degree is a bit poor (56.3%) to the diagnosis of SBP,.4. Plasma PCT is a clinical indicators in diagnosing of SBP, has e higher sensitivity (62.2%) and Specificity (75.0%).5. We can check the level of plasma HNP and PCT when SBP occurs, if the plasma HNP or PCT increased significantly is help to the diagnosis of SBP. |
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