Application Of Heparin Binding Protein In Ascites For Early Diagnosis Of Spontaneous Bacterial Peritonitis

Objective:Spontaneous bacterial peritonitis(SBP)is an acute bacterial inflammation of peritoneum which is without clear Perforation and local inflammation of the cavity.The incidence of spontaneous bacterial peritonitis(SBP)is mostly hidden,which is not conducive to early diagnosis.Heparin binding protein(HBP)can modulate inflammatory mediators and reaction,plays a role of antibacterial.SBP is also an inflammatory disease.The purpose of this study is to explore the early diagnostic value of HBP in ascites and to guide the early intervention in SBP.The level of serum procalcitonin(PCT)is higher after bacterial infection,which is not only reflects the systemic infection but also can be used for local infection.and the concentration of PCT in serum is not affected by non infectious factors.The purpose of this study is to explore the diagnostic value of serum PCT for spontaneous bacterial peritonitis.Methods:40 cases of cirrhotic ascites with SBP were selected as the study group,in our hospital from January 2016 to June 2017.while 40 cases of cirrhotic ascites without SBP in the same period were selected as the control group,Group of tuberculous ascites and group of cancer ascites are 20 cases in the other two groups respectively.All cases were performed with bacterial culture and PMN count of ascites then HBP in ascite and PCT in serum were detected.The accuracy of groups was verified.10 ml of ascites was extracted with aseptic and injected into blood culture bottles immediately.The full-automatic microorganism analyzer was used for drug sensitivity test and bacterial identification.The screening of the phenotypes of the strains of extended spectrum beta lactamase was confirmed by using K-B paper method and judged by the standard of antimicrobial susceptibility test recommended by the American clinical and Laboratory Standards Association.MRSA was tested by cefoxitin disk test.Routine examination of ascites.After sucking the 0.35mol/L glacial acetic acid,all of them are blown out,so that the straw wall can be attached to some glacial acetic acid.Then the same suction tube was used to absorb a small amount of mixed ascites to fill the pool.After 2-3 minutes,the nucleated cells in the central and five DAFS of the four corners were counted.The white cell count could be diluted with the white cell diluent,and then multiplied by the dilution multiplier for statistical analysis.Result:SBP group of cirrhotic ascites,There were 23 males and 17 females,with an average age of(62.3±9.7).Control group without SBP,There were 21 males and 19 females,with an average age of(65.2±7.4),and a group of tuberculous ascites.There were 12 males and 8 females,the average age was(59.7±7.2).There were 13 males and 7 women in cancer ascites group(60.4±8.1).There was no statistical difference in age between the four groups(P > 0.05).The HBP value of ascites in the SBP group of liver cirrhosis was(60.85±14.66)ng/mL,the HBP value of ascites in the non SBP group of cirrhotic ascites was(9.42±1.75)ng/mL,the HBP value in the carcinomatous ascites group was(13.74±3.07)ng/m L,the tuberculous ascites group was(9.23±1.49)ng/m L,and the concentration of the ascites HBP concentration in the SBP group of liver cirrhosis was significantly higher than that of the other three groups.(t=3.509,P=0.001,t=2.047,P=0.036,t=2.462,P=0.022),the difference was statistically significant.The PCT value of serum was(4.97±2.18)ng/mL,(0.28± 0.19)ng/mL,(0.37±0.08)ng/m L,(0.43±0.21)ng/m L in SBP group,non SBP group of cirrhotic ascites,carcinomatous ascites group,tuberculous ascites group.PCT concentration of Serum in SBP group of liver cirrhosis increased significantly compared with the other three groups(t=4.081,P=0.001,t=3.352,P=0.013,t=2.973,P=0.025),and the difference was statistically significant.The area under the ROC curve of ascites HBP was 0.962.When the best diagnostic value of SBP was 23.54 ng/mL,the sensitivity was 92.3% and the specificity was 65.4%.It is confirmed that the value of HBP in the diagnosis of SBP in cirrhotic ascites.The correlation between the HBP in ascites and PCT in serum was found to be highly correlated(r=0.776,P=0.000).Conclusions:1)the level of HBP in patients with cirrhotic ascites SBP is significantly higher than that of non SBP group,carcinomatous ascites group and tuberculous ascites group,which can be used as an early diagnostic indicator of SBP;2)the level of PCT in patients with SBP of cirrhotic ascites is significantly higher than that of non SBP group,carcinomatous ascites group and tuberculous ascites group.It can be used as an early diagnostic indicator of SBP in clinical practice;3)the ascites HBP in the SBP group of cirrhotic ascites has a significant correlation with the serum PCT,and the detection of the two can improve the diagnostic efficiency of SBP.