血清胃泌素与胃动素及炎症因子联合SIRS评分评估HBV-ACLF并发细菌感染的临床价值  

Clinical value of serum gastrin, motilin, inflammatory factors combined with SIRS score in evaluating HBV-ACLF complicated with bacterial infection

作　　者：刘英辉[1] 周东方[1] 金国华[1] 闫文昭[1] 程欣 LIU Ying-hui;ZHOU Dong-fang;JIN Guo-hua;YAN Wen-zhao;CHENG Xin(The Third Hospitalof Hebei Medical University,Shijiazhuang,Hebei050000,China)

机构地区：[1]河北医科大学第三医院感染科,河北石家庄050000

出　　处：《中华医院感染学杂志》2021年第11期1601-1606,共6页Chinese Journal of Nosocomiology

基　　金：河北省医学适用技术跟踪基金资助项目(G201734)。

摘　　要：目的研究血清胃泌素(GAS)、胃动素(MTL)、炎症因子并联合全身炎症反应综合征(SIRS)评分预测乙型肝炎病毒(HBV)相关慢加急性肝衰竭(HBV-ACLF)并发细菌感染的临床价值。方法选取2016年10月-2020年1月河北医科大学第三医院感染科收治的HBV-ACLF患者(研究组,n=124)及同期住院的慢性HBV感染患者(对照组,n=115),比较两组入院时血清GAS、MTL、炎症因子[C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)]、全身炎症反应综合征(SIRS)评分、并发细菌感染率,依据是否出现细菌感染将HBV-ACLF患者分为感染患者、未感染患者,比较感染与未感染患者、不同病情、不同肝功能Child-Pugh分级、不同预后HBV-ACLF患者的血清GAS、MTL、炎症因子、SIRS评分,分析血清GAS、MTL、炎症因子、SIRS评分的相关性,绘制受试者工作特征曲线(ROC)评估血清GAS、MTL、炎症因子、SIRS评分对HBV-ACLF并发细菌感染的预测价值。结果研究组入院时血清GAS、CRP、PCT、IL-6水平及SIRS评分、并发细菌感染率高于对照组,而MTL低于对照组(P<0.05);感染患者入院时血清GAS、CRP、PCT、IL-6水平及SIRS评分高于未感染患者,MTL低于未感染患者(P<0.05);脓毒性休克患者入院时血清GAS、CRP、PCT、IL-6水平及SIRS评分高于严重脓毒症、一般脓毒症,而MTL低于严重脓毒症、一般脓毒症(P<0.05);Child-Pugh分级B级患者入院时血清GAS、CRP、PCT、IL-6水平及SIRS评分低于C级患者,而MTL高于C级患者(P<0.05);入院28 d死亡者血清GAS、CRP、PCT、IL-6水平及SIRS评分高于预后良好者,MTL低于预后良好者(P<0.05);HBV-ACLF患者血清GAS、CRP、PCT、IL-6水平及SIRS评分两两存在正相关性,MTL与SIRS评分呈负相关(P<0.05);血清GAS、MTL、CRP、PCT、IL-6水平及SIRS评分联合预测HBV-ACLF并发细菌感染的曲线下面积为0.832,较各项单独预测时大。结论血清GAS、MTL、CRP、PCT、IL-6及SIRS评分用于预测HBV-ACLF患者并发OBJECTIVE To study the clinical value of serum gastrin(GAS),motilin(MTL),inflammatory factors combined with systemic inflammatory response syndrome(SIRS)scores in evaluating hepatitis B virus(HBV)-associated acute on chronic liver failure(HBV-ACLF)complicated with bacterial infection.METHODS HBV-ACLF patients(study group,n=124)and chronic HBV infection patients(control group,n=115)who were admitted to the Department of Infectious Disease of the Third Hospital of Hebei Medical University from Oct.2016 to Jan.2020 were selected.Serum GAS,MTL,inflammatory factors[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)],systemic inflammatory respones sydrome(SIRS)scores and bacterial infection rates between the two groups upon admission were compared.HBV-ACLF patients were divided into infected group and uninfected group according to the occurrence of bacterial infections.Serum GAS,MTL,inflammatory factors and SIRS scores of patients of the infected group and the uninfected group,different conditions,different Child-Pugh grades of liver function and different prognosis of HBV-ACLF were compared.The correlation of serum GAS,MTL,inflammatory factors and SIRS scores was analyzed,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum GAS,MTL,inflammatory factors and SIRS score for HBV-ACLF complicated with bacterial infection.RESULTS The serum GAS,CRP,PCT and IL-16 levels,SIRS scores and the rate of concurrent bacterial infection in the study group were significanttly higher than those in the control group,while MTL was significanttly lower than the control group at admission(P<0.05).Serum GAS,CRP,PCT and IL-16 levels and SIRS scores of patients in infected group on admission were significanttly higher than those of uninfected patients,and MTL was significanttly lower than that of uninfected group.The serum GAS,CRP,PCT,IL-6 levels and SIRS scores of patients with septic shock at admission were significanttly higher than severe sepsis and general sepsis,while MLT was sig

关 键 词：胃泌素 C-反应蛋白 SIRS评分 乙型肝炎病毒相关慢加急性肝衰竭 细菌感染 临床价值 

分 类 号：R446[医药卫生—诊断学]