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[目的]研究血清sCD14与腹水乳铁蛋白(LF)在肝硬化自发性细菌性腹膜炎诊治中的意义。[方法]选取我院在2014年3月~2016年7月期间收治的88例肝硬化患者,根据病患者病情将患者分成肝硬化自发性细菌性腹膜炎组(A组=30例)与单纯性腹水肝硬化组(B组=58例),同时另选取44例来我院做常规检查的健康居民作为对照组。抽取患者的血液以及腹水送至实验室进行检查,采用免疫层析法检测腹水乳铁蛋白,采用细胞分流术检测sCD14的表达水平,观察腹水乳铁蛋白与sCD14对肝硬化自发性细菌性腹膜炎患者的诊治意义。[结果]A组患者sCD14、WBC、ALT、AST为[(47.59±11.34)mg/L、(16.75±3.25)×10~9/L、(156.85±32.61)U/ml、(132.65±23.51)U/ml],显著高于B组与对照组[(3.64±0.57)mg/L、(8.41±1.21)×10~9/L、(45.26±6.61)U/ml、(36.43±9.62)U/ml,(0.52±0.11)mg/L、(7.45±1.03)×10~9/L、(37.24±5.14)U/ml、(31.24±5.41)U/ml,(P<0.05)];A组患者LF阳性表达率为(90.00%)、表达水平为(162.52±37.21)ng/ml,显著高于B组[(17.24%)、(76.49±11.24)ng/ml、(P<0.05)];经Spearman等级相关性分析显示,血清sCD14、腹水LF水平随自发性细菌性腹膜炎患者Child-Pugh分级升高而增加[r=0.814、r=0.734,P<0.05]。组间比较,Child-PughC级患者血清sCD14与LF水平最高,Child-PughB级患者血清sCD14与LF水平次之,Child-PughA级患者血清sCD14与LF水平最低,经综合治疗后,A组患者sCD14与LF值为[(4.63±1.02)mg/L、(35.62±11.02)ng/ml],显著低于治疗前[(47.59±11.34)mg/L、(162.52±37.21)ng/ml,(P<0.05)],B组患者治疗后sCD14与LF值为[(0.51±0.12)mg/L、(33.02±10.34)ng/ml],显著低于治疗前[(0.76±0.21)mg/L、(76.49±11.24)ng/ml,(P<0.05)]。[结论]血清sCD14与腹水LF在肝硬化自发性细菌性腹膜炎的早期诊断中具有重要的临床意义,对自发性细菌性腹膜炎与无菌性腹膜炎具有鉴别诊断意义,并且还能用于预测Child-Pugh的分级,为临床上疾病评估提供相应的参考依据。
[Objective] To investigate the significance of serum sCD14 and ascites lactoferrin (LF) in the diagnosis and treatment of spontaneous bacterial peritonitis of liver cirrhosis. [Methods] Eighty-eight patients with cirrhosis who were treated in our hospital from March 2014 to July 2016 were selected and divided into three groups according to their illness: spontaneous bacterial peritonitis (A group = 30 cases) and simple cirrhosis Ascites cirrhosis group (B group = 58 cases), while the other 44 cases were selected to routine inspection of our hospital healthy people as a control group. The patient’s blood and ascites were taken to the laboratory for examination. The ascites lactoferrin was detected by immunochromatography. The expression of sCD14 was detected by cell shunting. The effects of ascites lactoferrin and sCD14 on patients with spontaneous bacterial peritonitis The significance of diagnosis and treatment. [Results] The values of sCD14, WBC, ALT and AST in group A were (47.59 ± 11.34) mg / L, (16.75 ± 3.25) × 10-9 / L, (156.85 ± 32.61) U / ml and (132.65 ± 23.51) U / ml] was significantly higher than that of the control group [(3.64 ± 0.57) mg / L, (8.41 ± 1.21) × 10-9 / L, (45.26 ± 6.61) U / ml and (36.43 ± 9.62) U (0.52 ± 0.1) mg / L, (7.45 ± 1.03) × 10~9 / L, (37.24 ± 5.14) U / ml, (31.24 ± 5.41) The positive expression rate of LF in group B was (90.00%) and the expression level was (162.52 ± 37.21) ng / ml, which was significantly higher than that in group B [(17.24%) and (76.49 ± 11.24) ng / ; Spearman rank correlation analysis showed that serum sCD14 and ascites LF levels increased with Child-Pugh grading in patients with spontaneous bacterial peritonitis [r = 0.814, r = 0.734, P <0.05]. The serum levels of sCD14 and LF in Child-PughC patients were the highest, while the serum levels of sCD14 and LF in Child-PughB patients were the lowest. The levels of sCD14 and LF in Child-PughA patients were the lowest. After combined treatment, (P <0.05), and the value of LF was (4.63 ± 1.02) mg / L and (35.62 ± 11.02) ng / ml respectively, significantly lower than that before treatment [(47.59 ± 11.34) mg / 0.05). The sCD14 and LF values in group B were significantly lower than those before treatment [(0.61 ± 0.12) mg / L, (33.02 ± 10.34) ng / (76.49 ± 11.24) ng / ml, (P <0.05)]. [Conclusion] Serum sCD14 and ascites LF have important clinical significance in the early diagnosis of spontaneous bacterial peritonitis of liver cirrhosis. They have the significance of differential diagnosis between spontaneous bacterial peritonitis and aseptic peritonitis, and can also be used to predict Child- Pugh’s classification for clinical disease assessment provide the appropriate reference.