脂多糖结合蛋白联合白介素-6、肿瘤坏死因子-α水平检测对产褥期感染早期诊断价值  

The value of lipopolysaccharide binding protein combined with interleukin-6 and tumor necrosis factor alpha in early diagnosis of puerperal infection

作　　者：蒋晓辉[1] 李宁 刘舒鑫[1] JIANG Xiaohui;LI Ning;LIU Shuxin(The first people's Hospital of Zhengzhou,Henan,Zhengzhou,450004)

机构地区：[1]郑州市第一人民医院产一科,河南郑州450004

出　　处：《实验与检验医学》2021年第1期26-30,共5页Experimental and Laboratory Medicine

基　　金：河南省医学科技攻关计划项目,编号201706114。

摘　　要：目的研究脂多糖结合蛋白(LBP)联合白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平检测在产褥期感染早期的诊断价值。方法选取2016年1月至2018年5月产褥期感染者86例,为感染组(放弃治疗2例、生存84例);正常分娩产褥期未感染者90例,为未感染组;健康体检女性44例,为对照组。疑似感染时(T0)、感染24h(T1)、感染48h(T2)、感染控制时(T3)测定传统感染指标(白细胞(WBC)、降钙素原(PCT))、LBP、IL-6、TNF-α水平及未感染组、对照组对象指标水平。绘制受试者工作特征曲线(ROC曲线)。比较曲线下面积(AUC)大小,明确诊断灵敏度、特异性。结果T0时,感染组WBC、PCT、LBP、IL-6、TNF-α水平均高于未感染组、对照组,差异有统计学意义(P<0.05);未感染组高于对照组,但差异无统计学意义(P>0.05)。T1、T2、T3时,感染组WBC、PCT、LBP、IL-6、TNF-α水平先升高、后下降,差异均有统计学意义(P<0.05)。T0、T1、T2、T3时,产褥感染放弃治疗者WBC、PCT、LBP、IL-6、TNF-α水平呈不断升高趋势,产褥感染生存者呈先升高、后下降趋势,差异均有统计学意义(P<0.05);且各个时刻,放弃治疗者水平均高于生存者,差异均有统计学意义(P<0.05)。LBP、IL-6、TNF-α和LBP联合IL-6、TNF-α曲线下面积分别为0.790、0.580、0.714和0.829,AUC均>0.50。LBP联合IL-6、TNF-α水平检测早期诊断产褥期感染敏感度81.40%、特异性94.44%、阳性预测值93.33%、阴性预测值84.16%,均高于LBP的74.42%、74.44%、73.56%、75.28%,IL-6的60.47%、65.56%、62.65%、63.44%,TNF-α的66.28%、66.67%、65.52%、67.42%,差异均有统计学意义(P<0.05)。结论LBP联合IL-6、TNF-α水平动态检测,利于提高产褥期感染早期诊断率及早期诊断灵敏度与特异性,从而为临床提供更加有效的参考信息及依据。Objective To study the early diagnostic value of lipopolysaccharide binding protein(LBP)combined with interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)levels in puerperal infection.Methods From January 2016 to May 2018,86 cases of puerperal infection were selected as the infection group(2 patients gave up treatment,84 patients survived);90 cases of normal labor during the puerperium stage were uninfected;44 cases of physical examination were the control group.Suspected infection(T0),infection 24h(T1),infection 48h(T2),infection control(T3),traditional infection indicators(white blood cell(WBC),procalcitonin(PCT)),LBP,IL-6,The level of TNF-αand the target levels of the uninfected and control subjects were determined.The receiver operating characteristic curve(ROC curve)were drawn.The area under the curve(AUC)was compared to determine the sensitivity and specificity of the diagnosis.Results At T0,the WBC,PCT,LBP,IL-6 and TNF-αlevels in the infected group were higher than those in the uninfected group and the control group(P<0.05).The uninfected group was higher than the control group,but the difference was not statistically significant(P>0.05).At T1,T2,and T3,the levels of WBC,PCT,LBP,IL-6,and TNF-αin the infection group increased first and then decreased,and the differences were statistically significant(P<0.05).At T0,T1,T2 and T3,the levels of WBC,PCT,LBP,IL-6 and TNF-αin the treatment of puerperal infection were increasing,and the survivors of puerperal infection increased first and then decreased.All were statistically significant(P<0.05);and at each time,the abandonment of treatment was higher than survivors,and the difference was statistically significant(P<0.05).The areas under the curves of LBP,IL-6,TNF-αand LBP combined with IL-6 and TNF-αwere 0.790,0.580,0.714 and 0.829,respectively,and the AUC was>0.50.LBP combined with IL-6 and TNF-αlevels detected 81.40%of puerperal infection sensitivity,94.44%specificity,93.33%positive predictive value,and 84.16%negative predictive value,which were higher

关 键 词：产褥期感染 早期诊断 脂多糖结合蛋白 白介素-6 肿瘤坏死因子-Α 

分 类 号：R446.112[医药卫生—诊断学] R714.62[医药卫生—临床医学]