纤维蛋白原、C-反应蛋白和白细胞介素-6对肛周脓肿和肛瘘的辅助鉴别诊断价值  

Value of fibrinogen,C-reactive protein and interleukin 6 in diagnosis of perianal abscess and anal fistula

作　　者：胡雪玲[1] 宋佳希 牛冬梅 吴雪芸[1] HU Xue-ling;SONG Jia-xi;NIU Dong-mei;WU Xue-yun(Department of Laboratory Medicine,Nanjing Hospital of Chinese Medicine,Nanjing 210001,Jiangsu,China)

机构地区：[1]南京市中医院检验科,南京210001

出　　处：《东南国防医药》2021年第3期262-266,共5页Military Medical Journal of Southeast China

基　　金：江苏省青年医学重点人才项目(QNRC2016892);南京市中医院科研基金项目(YJLC201908)。

摘　　要：目的分析肛周脓肿和肛瘘患者纤维蛋白原(FIB)、C-反应蛋白(CRP)和白细胞介素-6(IL-6)水平,探讨FIB、CRP和IL-6对肛周脓肿和肛瘘鉴别诊断的临床价值。方法选取2019年6-12月在南京市中医院肛肠科住院并确诊的肛周脓肿患者106例(肛周脓肿组)和肛瘘患者102例(肛瘘组),另入选同期体检中心健康体检人员108例作为健康对照组。分别检测各组FIB、IL-6、CRP、白细胞总数和中性粒细胞百分比的水平,同时对肛周感染部位做脓液培养,观察致病菌种类;采用受试者工作特征曲线(ROC)评估FIB、IL-6和CRP对肛周脓肿和肛瘘的诊断效能;采用单因素相关分析和多元线性回归分析FIB与CRP、IL-6的关系。结果肛周脓肿组患者较肛瘘组患者FIB[4.50(3.54,5.67)vs 2.28(1.93,2.69)g/L]、IL-6[12.25(5.51,23.20)vs 1.95(1.20,4.31)ng/L]和CRP[27.00(10.00,50.50)vs 1.00(0.60,2.00)mg/L]水平均显著升高(P<0.01)。ROC曲线分析显示,FIB鉴别肛周脓肿和肛瘘的ROC曲线下面积(AUC)为0.941(95%CI:0.907~0.974,P<0.01),其诊断效能高于CRP[AUC为0.910(95%CI:0.866~0.955,P<0.01)]和IL-6[AUC为0.814(95%CI:0.746~0.882,P<0.01)]。肛周脓肿患者FIB水平分别与CRP(r=0.705,P<0.01)、IL-6水平(r=0.584,P<0.01)、白细胞总数(r=0.454,P<0.01)和中性粒细胞百分比(r=0.523,P<0.01)呈显著正相关。进一步逐步多元线性回归分析显示,在校正其他相关因素的影响下,CRP水平(β=0.465,P<0.01)和中性粒细胞百分比(β=0.341,P<0.01)共同决定了47.1%FIB的变化[决定系数(r 2)=0.471)]。结论肛周脓肿患者者血浆FIB的水平明显高于肛瘘患者,具有较好的特异性和敏感性,有望成为肛周脓肿和肛瘘鉴别诊断的辅助指标。Objective This study was aimed to analyze the expression levels of fibrinogen(FIB),C-reactive protein(CRP)and interleukin-6(IL-6)in patients with perianal abscess and anal fistula,and to explore the value of fibrinogen,CRP and IL-6 in diagnosis of perianal abscess and anal fistula.Methods A total of 106 patients with perianal abscess and 102 patients with anal fistula were admitted to Nanjing Hospital of T.C.M from June 2019 to December 2019.And 108 healthy controls who had contemporaneously visited Nanjing Hospital of T.C.M for a routine medical examination.The differential expression of FIB,CRP,IL-6,total number of white blood cells and percentage of neutrophils level among groups of perianal abscess,anal fistula and control were analyzed.Pus culture was performed on the site of perianal infection,and the pathogenic bacteria were observed.Receiver operating characteristic(ROC)curve analyses were used to assess the performance of FIB,IL-6 and CRP in perianal abscess or anal fistula prediction.The associations of FIB with CRP and IL-6 were analyzed by correlations and stepwise multiple linear regression analyses.Results Compared with anal fistula,the levels of FIB[4.50(3.54,5.67)vs 2.28(1.93,2.69)g/L],IL-6[12.25(5.51,23.20)vs 1.95(1.20,4.31)ng/L]and CRP[27.00(10.00,50.50)vs 1.00(0.60,2.00)mg/L]were significantly increased in patients with perianal abscess(all P<0.01).The areas undercurve(AUC)of FIB for predicting perianal abscess and anal fistula were 0.941(95%CI:0.907-0.974,P<0.01),which was superior to those of CRP[AUC 0.910(95%CI:0.866-0.955,P<0.01)]and IL-6[AUC 0.814(95%CI:0.746-0.882,P<0.01)].The FIB levels were positively correlated with CRP(r=0.705,P<0.01),IL-6 levels(r=0.584,P<0.01),total leukocyte count(r=0.454,P<0.01)and neutrophils percentage(r=0.523,P<0.01)in perianal abscess patients.The multiple linear regression analysis showed that CRP(β=0.465,P<0.01)and neutrophils percentage(β=0.341,P<0.01)accounted for 47.1%of the variation in FIB(r 2=0.471).Conclusion The level of plasma FIB in perianal absc

关 键 词：纤维蛋白原 白细胞介素-6 C反应蛋白 肛周脓肿 肛瘘 

分 类 号：R446.1[医药卫生—诊断学]