腹水前列腺素E2在诊断自发性腹膜炎和预测住院死亡率中的价值研究

Value of prostaglandin E2 level in peritoneal fluid in the diagnosis of spontaneous bacterial peritonitis and prediction of in-hospital mortality

摘要:

目的：探索腹水前列腺素E2（prostaglandin E2，PGE2）水平在诊断自发性腹膜炎（spontaneous bacterial peritonitis，SBP）和预测住院死亡率中的价值。方法：纳入2016年8月至2018年2月入住重庆医科大学附属第一医院的失代偿期肝硬化伴腹水患者，收集患者人口学资料及实验室检查结果，收集腹水标本并采用酶联免疫吸附法（enzyme-linked immunosorbent assay，ELISA）测量腹水中的PGE2浓度。采用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）分析腹水PGE2诊断SBP的灵敏度及特异度，单因素和多因素logistic回归分析对腹水PGE2预测住院死亡率进行分析。结果：共纳入193例肝硬化伴腹水患者，30例（15.5％）诊断为SBP。SBP患者组的腹水PGE2水平为32.77（26.05~39.68） pg/mL，明显低于非SBP患者组的腹水PGE2水平的49.72（37.35~55.14） pg/mL。ROC分析中，腹水PGE2的曲线下面积（area under the curve，AUC）为0.80，分界值为40.30 pg/mL，灵敏度为93.3%，特异度为58.3%。腹水PGE2≤32.88 pg/mL为失代偿期肝硬化患者住院死亡率的预测因子（OR=7.690，95%CI=2.357~25.088，P=0.001）。结论：腹水PGE2水平可作为诊断SBP和预测失代偿期肝硬化患者住院死亡率有价值的生物标志物。

Abstract:

Objective：To explore the value of prostaglandin E2 （PGE2） level in peritoneal fluid in the diagnosis of spontaneous bac－terial peritonitis（SBP） and prediction of in-hospital mortality. Methods：Patients with decompensated cirrhosis and ascites admitted to The First Affiliated Hospital of Chongqing Medical University from August 2016 to February 2018 were enrolled. Patients’ demograph－ic information and laboratory test results were collected. Peritoneal fluid samples were collected，and the PGE2 levels were measured by enzyme-linked immunosorbent assay. The sensitivity and specificity of PGE2 level in the diagnosis of SBP were analyzed by the receiver operating characteristic（ROC） curve. Univariate and multivariate logistic regression analyses were used to evaluate the pre－dictive value of PGE2 level for in-hospital mortality. Results：A total of 193 patients with liver cirrhosis and ascites were enrolled，and 30（15.5%） of them were diagnosed with SBP. The SBP group had a significantly lower PGE2 level than the non-SBP group[32.77（26.05-39.68） pg/mL vs. 49.72（37.35-55.14） pg/mL]. The ROC analysis showed that in the diagnosis of SBP，PGE2 level in peri－toneal fluid had an area under the ROC curve of 0.80，and had a sensitivity of 93.3% and a specificity of 58.3% at a cut-off value of 40.30 pg/mL. Peritoneal fluid PGE2≤32.88 pg/mL was a predictor of in-hospital mortality in patients with decompensated cirrhosis （OR=7.690，95%CI=2.357-25.088，P=0.001）. Conclusion：PGE2 level in peritoneal fluid can be used as a valuable biomarker for the diagnosis of SBP and the prediction of in-hospital mor－tality in patients with decompensated cirrhosis.