慢加急性乙型肝炎肝衰竭患者血清CRP和sTREM-1水平变化及其预测继发感染的价值研究OACSTPCD
Assessment of bacterial infection by serum CRP and sTREM-1 levels in patients with hepatitis B virus-associated acute-on-chronic liver failure
目的 探讨应用血清C反应蛋白(CRP)联合可溶性髓系细胞触发受体-1(sTREM-1)水平判断慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者继发感染的效能.方法 2020 年 2 月～2023 年 2 月我院诊治的HBV-ACLF患者 96例,采用ELISA法检测血清CRP和sTREM-1,应用多因素Logistic回归分析HBV-ACLF患者继发感染的影响因子,绘制受试者工作特性曲线(ROC)评估指标的诊断效能.结果 在本组纳入的 96 例 HBV-ACLF 患者中,继发感染 67 例(69.8％),其中自发性细菌性腹膜炎占 40.3％,肺部感染占 31.3％,泌尿道感染占 11.9％,胆道感染和肠道感染各占4.5％,皮肤软组织感染占 7.5％;感染组终末期肝病模型(MELD)和慢性肝衰竭-序贯器官衰竭评估模型评分(CLIF-SOFA)分别为(15.7±3.0)和(8.5±1.1)分,显著高于未感染组[分别为(12.40±3.00)和(6.1±1.0),P<0.05];感染组CRP和sTREM-1 水平分别为(52.2±4.6)mg/L和(29.9±5.8)pg/mL,显著高于未感染组[分别为(10.1±3.3)mg/L和(13.3±4.1)pg/mL,P<0.05];Logistic回归分析显示,INR、CRP、sTREM-1 和降钙素原(PCT)均为影响HBV-ACLF患者继发感染的独立危险因子(P<0.05);ROC曲线分析显示,血清CRP 联合sTREM-1 水平诊断HBV-ACLF患者继发感染的AUC为0.906,其灵敏度和特异度分别为98.5％和82.8％,显著优于两指标单独诊断(P<0.05).结论 应用血清CRP和sTREM-1 联合检测可辅助诊断HBV-ACLF患者继发感染的存在,具有一定的临床价值.
Objective The purpose of this study was to investigate the diagnostic efficacy of serum C-reactive protein(CRP)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)levels for secondary infections in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).Methods 96 consecutive patients with HBV-ACLF were encountered in our hospital between February 2020 and February 2023.Serum CRP and sTREM-1 levels were measured by ELISA.The multivariate Logistic regression analysis was conducted to identify the influencing factors for secondary infections in patients with HBV-ACLF.The diagnostic performance of above parameters was evaluated by using the receiver operating characteristic(ROC)curve.Results 67(69.8%)patients with HBV-ACLF in our series developed secondary infections,and the spontaneous bacterial peritonitis,pulmonary infection,urinary tract infection,biliary tract infection,intestinal infection,and skin and soft tissue infection accounted for 40.3%,31.3%,11.9%,4.5%,4.5%,and 7.5%,respectively;the model of end-stage liver disease score and chronic liver failure sequential organ failure assessment score in patients with infection were(15.7±3.0)and(8.5±1.1),both significantly greater than[(12.40±3.00)and(6.1±1.0),P<0.05]in patients without infection;serum CRP and sTREM-1 levels in patients with infection were(52.2±4.6)mg/L and(29.9±5.8)pg/mL,both much higher than[(10.1±3.3)mg/L and(13.3±4.1)pg/mL,P<0.05]in those without;the Logistic regression analysis showed that the international normalization ratio,serum CRP,sTREM-1 and procalcitonin levels were all the independent risk factors for secondary infection(P<0.05);the ROC analysis demonstrated that the AUC was0.906,with the sensitivity of 98.5%and the specificity of 82.8%,when serum CRP and sTREM-1 level combination was applied to predict the existence of infection,much superior to any parameter alone(P<0.05).Conclusion The surveillance of serum CRP and sTREM-1 level could help diagnose the secondary infections in patients with HBV-ACLF,which needs further clinical investigation.
柯海霞;张娇珍;蒙夏玲;许政衡;邓丕豪
570216 海口市中医医院检验科海南医学院第一附属医院泌尿外科
慢加急性肝衰竭C反应蛋白可溶性髓系细胞触发受体-1感染诊断
Acute-on-chronic liver failureC-reactive proteinSoluble triggering receptor expressed on myeloid cells-1Secondary infectionDiagnosis
《实用肝脏病杂志》 2024 (004)
555-558 / 4
海南省自然科学基金面上项目(编号:821MS168)
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