The Clinical Study Of The Serum PCT、LPS Test In Hepatitis B Cirrhosis Patients With SBP

BackgroundHepatitis B virus (HBV) infection is epidemic in china，Hepatitis B surfaceantigen (HBSAg) carrying rate is about350million in the world，including about120million in our country. Adolescent patients is easy to develop into chronic Hepatitis Binfection，then to cirrhosis of the liver，The patient with decompensatory cirrhosis ofliver woule get higher fatalig rate. There are a variety of causes lead to the cirrhosisof the liver，some reports suggest that secondary intestinal and respiratory tractinfection is the main cause，followed by upper gastrointestinal bleeding，drinking. Onthe basis of cirrhosis of the liver，secondary bacterial infection can produce endotoxinhematic disease，so as to activate macrophages release cytokines and tumor necrosisfactor and so on，it can increase the damage of the liver in decompensation period andthe prognosis of patients with hepatitis B cirrhosis are many related factors，secondary infection for the inducing factors of cirrhosis of the liver illness.Decompensation period of hepatitis B patients with liver cirrhosis is decreasing dueto secondary infection and illness through the early diagnosis，comprehensivemeasures such as strengthening the resistance to infection，improve the level ofimmune could control the disease.Spontaneous bacterial peritonitis (SBP) is a common and serious complication in patients with hepatocirrhosis and ascites，it is pathogenic bacteria through theintestinal tract，blood or lymphatic system caused by abdominal cavity infection，andno abdominal cavity adjacent organs directly bacterial infection sources (such asintestinal perforation) issued in abdominal cavity infection. Hepatocirrhosis withascites of SBP1year incidence is10%~25%，and for routine puncture operation rateis10%~27%in hospitalized patients. With the improvement of understanding ofSBP，early detection，the application of the new diagnosis technology and effectiveearly application of antimicrobial agents，caused by a SBP infection mortality hasdeclined obviously，but due to the lack of typical clinical manifestations of SBPascites germiculture positive rate is low，lead to many SBP patients still can not getearly diagnosis and treatment. And now on the forming mechanism of SBP is not veryclear，think more and intestinal mucosal permeability increase，intestinal floradisturbance，migration of gut bacteria and the body’s immune function decline andother factors. In recent years， more attention paid to the systemic and localimmunological disorders research， many scholars believe ascites active ingredientsnot only participated in the ascites formation，and local immunosuppression mediatedthe abdominal cavity. Therefore，add or neutralize some active ingredient content inascites or role，can improve abdominal local immune status，the inhibition of ascitesformation，delay or prevent cancer spread of abdominal cavity. Still，many activeingredients of fluid has certain limitation，early infection tend to increase，but with thefurther development of infection，is likely to decline gradually，and many humoralactive ingredient is influenced by individual factors， thus active ingredient for allkinds of body fluids to comprehensive analysis and evaluation，could bring thebenefits for the early diagnosis and treatment of SBP.Now there are many mathods to assist detection SBP，in which a variety ofcytokines and general electric (GE)，ascites pH affected by a variety of other factorsin addition to the infection. AFLAC rapid diagnosis of SBP value more reliable，morepromising，and white blood cells of lipase in addition to rapid diagnosis reagent withmethod，sensitivity and specific degree is higher，simple，inexpensive，the applicationprospect of larger; BacT/ALERT and blood culture method sensitivity is similar，butthe former can be more early diagnosis; Serum PCT can be used as a useful on SBP in patients with cirrhosis diagnosis index，can be in2h sequence，moderate cost，but thedetection of PCT and other inflammatory factor method still needs further research;NO level is not used in the diagnosis of SBP or a susceptible factor of SBP，but maybe a useful prognostic indicator; Early detection of bacterial DNA method not onlycould help predict SBP，and to study the etiology and pathogenesis of SBP useful.SBP is the main complication of liver cirrhosis patients with ascites. In patientswith liver cirrhosis ascites in hospital，the incidence is8%~30%. SBP and fatalityrate of varicose veins rupture hemorrhage roughly equal，close to30%~50%. Inrecent10years in the case fatality rate is still20%~40%. Early diagnosis is the keyto the treatment of SBP，recent clinical consensus，regardless of peritoneal signs andsymptoms of infection，patients with liver cirrhosis ascites should be line diagnosticabdominal puncture，doing routine ascites and bacterial culture. Current criteria fordiagnosis of SBP is the2000agreement，namely:1. The fever，abdominal pain，abdominal tenderness and bounce painful symptoms and signs such as2. Ascitescheck leucocyte>500x106/L，neutrophils (PMN)>250x106/L3. Ascites germiculturepositive. Have the above two criteria，and except for tuberculous，cancerous ascitesand abdominal viscera rupture or perforation caused by diffuse peritonitis. Withascites polymorphonuclear granulocyte(PMN)>250x106/L for immediate the standardin the diagnosis of SBP. But the existing ascites PMN count and ascites cultivationmethods have higher request for inspection personnel，require a long time，alsotransfer process from pollution，and human error，not conducive to rapid diagnosis atthe grassroots medical institutions and the emergency department，and ascites culturepositive rate is very low，foreign coverage is only40%，at home，because of variousreason， the positive rate less than40%，and emergency test cannot get it，which isnot conducive to early diagnosis and treatment，so we need to find other quick andeasy test methods.ObjectiveTo explore the predictive value of serum PCT、LPS in hepatitis B cirrhosisassociated with spontaneous bacterial peritonitis (SBP). ApproachCollect58hospitalized patients with hepatitis B cirrhosis and ascites. Patientswith SBP28cases，no SBP30cases. Examine the serum PCT，LPS levels of twogroups patients’. Antimicrobial therapy in patients with SBP group after48h，someeffective review of20patients，compare the serum levels of PCT and LPS with theresults before treatment.ResultHepatitis B cirrhosis of the liver with SBP group has a significantly higher serumPCT，LPS level than without SBP group，in SBP group，20patients after48htreatment serum PCT was significantly lower，the serum PCT in comparativedifference was statistically significant before and after the treatment; Higher serumLPS earlier，there was no statistically significant difference.ConclusionSerum PCT，LPS test is helpful to the diagnosis of hepatitis B patients withSBP，serum PCT level has closed relationship with disease prognosis.