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慢加急性乙型肝炎肝衰竭患者细菌感染病原菌分布及血清PCT、IFN-γ和IL-6水平变化分析OACSTPCD

Pathogenic bacteria distribution and serum IFN-γ and IL-6 level changes in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by bacterial infections

中文摘要英文摘要

目的 调查慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者细菌感染病原菌分布特征,分析血清降钙素原(PCT)、干扰素-γ(IFN-γ)和白细胞介素-6(IL-6)水平预测细菌感染的效能.方法 2019 年12 月~2023 年1 月我院收治的HBV-ACLF患者86 例,常规分离和鉴定菌种,采用电化学发光免疫法检测血清PCT水平,采用ELISA法检测血清IFN-γ和IL-6 水平,应用受试者工作特征(ROC)曲线评估血清指标联合预测HBV-ACLF患者发生细菌感染的效能.结果 本组发生细菌感染者37 例,未发生明确感染者49 例;在37 例HBV-ACLF并发细菌感染患者中,共检出68 株感染病原菌,其中革兰氏阴性菌41 株(60.3%),革兰氏阳性菌 27 株(39.7%);感染组血清 PCT、IFN-γ和 IL-6 水平分别为(10.9±3.1)μg/L、(46.5±1.9)pg/mL和(16.9±1.6)pg/mL,均显著高于未感染组[分别为(0.9±0.1)μg/L、(20.1±2.4)pg/mL和(4.8±0.9)pg/mL,P<0.05],28 d和90d病死率分别为67.6%和75.7%,均显著高于未感染组(分别为8.2%和12.2%,P<0.05);经ROC分析显示,分别以PCT>3.3μg/L、IFN-γ>45.5 pg/mL和IL-6>15.4pg/mL为截断点,其联合预测HBV-ACLF患者并发细菌感染的曲线下面积(AUC)为0.874,诊断的灵敏度为93.6%,特异度为84.1%.结论 HBV-ACLF患者细菌感染的病原菌分布具有一定的特征性,以革兰氏阴性菌感染为主,除检测血清PCT水平外,监测血清IFN-γ和IL-6 水平可能有助于早期发现细菌感染而给予预防性处理,或能提供生存率.

Objective The aim of this study was to investigate the pathogenic bacteria distribution and serum interferon-gamma(IFN-γ)and interleukin-6(IL-6)level changes in patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)complicated by bacterial infections.Methods 86 patients with HBV-ACLF were admitted to our hospital between December 2019 and January 2023,and the bacteria were isolated and identified routinely.Serum procalcitonin(PCT)level was detected by electrochemiluminescence immunoassay,and serum IFN-γ and IL-6 levels were assayed by ELISA.The diagnostic performance was evaluated by the area under the receiver operating characteristic(ROC)curve.Results 37 patients in our series were found having bacterial infection,and out of them,68 pathogenic bacteria strains were characterized with Gram-negative bacteria infection in 41 strains and Gram-positive bacterial infection in 27 strains(39.7%);serum PCT,IFN-γ and IL-6 levels in patients with bacterial infection were(10.9±3.1)μg/L,(46.5±1.9)pg/mL and(16.9±1.6)pg/mL,all significantly higher[(0.9±0.1)μg/L,(20.1±2.4)pg/mL and(4.8±0.9)pg/mL,respectively,P<0.05],and 28-day and 90-day fatality rates were 67.6%and 75.7%,both significantly higher than 8.2%and 12.2%(P<0.05)in patients without bacterial infection;the ROC analysis showed that the AUC was 0.874,with the sensitivity of 93.6%and the specificity of 84.1%,when the combination of serum parameters was applied to predict bacterial infection as serum PCT>3.3μg/L,serum IFN-γ>45.5 pg/mL and IL-6>15.4 pg/mL was set as the cut-off-value.Conclusion The distribution of pathogenic bacteria in patients with HBV-ACLF complicated by bacterial infections is characteristic,and the Gram-negative bacteria is the main common pathogenic bacteria.Besides serum PCT level,the surveillance of serum IFN-γ and IL-6 levels is helpful for early diagnosis of bacterial infection in this setting.

杨晶;陈美玲;张丽秀;颜鲁伟;白正强;贺锐

730070 兰州市甘肃省妇幼保健院/甘肃省中心医院临床检验中心兰州大学第二附属医院神经外科

慢加急性乙型肝炎肝衰竭细菌感染降钙素原、干扰素-γ白细胞介素-6诊断

Acute-on-chronic liver failureBacterial infectionProcalcitoninInterferon-gammaInterleukin-6Di-agnosis

《实用肝脏病杂志》 2024 (001)

64-67 / 4

甘肃省科技厅重点研发计划项目(编号:20YF3FA013)

10.3969/j.issn.1672-5069.2024.01.017

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