可溶性白细胞分化抗原14亚型对慢加急性肝衰竭合并脓毒症的临床诊断价值  

Diagnostic value of soluble leukocyte differentiation antigen 14 subtype to patients with sepsis based on chronic acute liver failure

作　　者：马娟[1] 张旭[1] 张爱芸[1] 孙静[2] 韩凯明 王煜[1] Ma Juan;Zhang Xu;Zhang Aiyun;Sun Jing;Han Kaiming;Wang Yu(Department of Infectious Diseases,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Graduate School of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院感染疾病科,银川750004 [2]宁夏医科大学研究生院,银川750004

出　　处：《国际流行病学传染病学杂志》2021年第4期291-295,共5页International Journal of Epidemiology and Infectious Disease

基　　金：宁夏高等学校科学研究项目(NGY2020046)。

摘　　要：目的:探讨血清可溶性白细胞分化抗原14亚型(sCD14-ST)水平对慢加急性肝衰竭(ACLF)合并脓毒症患者的诊断价值。方法:收集2018—2019年宁夏医科大学总医院收治的ACLF合并脓毒症患者67例(脓毒症组)、ACLF无脓毒症患者82例(非脓毒症组)的临床资料,脓毒症患者根据病原学培养结果分为阳性组(25例)和阴性组(42例)。检测疾病早期血清sCD14-ST、降钙素原(PCT)、C反应蛋白(CRP)及中性粒细胞(NE)水平。采用Pearson相关性检验分析sCD14-ST、PCT、CRP的相关性,并绘制ROC曲线。结果:脓毒症组中以自发性腹膜炎37例(55.22%)和肺部感染25例(37.31%)为主;病原学培养阳性25例,其中革兰阳性菌9例(36.0%),革兰阴性菌16例(64.0%)。ACLF脓毒症组血清sCD14-ST、PCT、CRP及NE水平均明显高于ACLF非脓毒症组(t=12.425、8.296、9.238和6.655,P均<0.05);脓毒症患者病原学阳性组血清sCD14-ST、PCT、CRP水平明显高于病原学阴性组(t=12.230、4.114和5.307,P均<0.05)。Pearson相关性分析显示,脓毒症组血清sCD14-ST与PCT、CRP呈正相关(r=0.813和0.773,P均<0.01)。血清sCD14-ST、PCT、CRP联合检测的灵敏度和特异性最高(87.11%和96.74%),曲线下面积0.946。结论:ACLF合并脓毒症常见感染部位以腹腔及肺部为主,菌群以革兰阴性菌为主。血清sCD14-ST、PCT及CRP联合检测有助于ACLF合并脓毒症患者的早期诊断。Objective To investigate the diagnostic value of serum soluble leukocyte differentiation antigen 14 subtype(sCD14-ST)level in patients with chronic acute liver failure(ACLF)complicated with sepsis.Methods There were 67 patients with ACLF and sepsis selected as sepsis group in General Hospital of Ningxia Medical University from 2018 to 2019,and 82 patients with ACLF were selected as non-sepsis group.The ACLF patients with sepsis were divided into pathogen-positive group(25 cases)and pathogen-negative group(42 cases)according to pathogenic culture results.The levels of serum sCD14-ST,procalcitonin(PCT),C-reactive protein(CRP)and neutrophil(NE)were detected at early stage of disease.Pearson correlation test was used to analyze the correlation of sCD14-ST,PCR and CRP,and ROC curve was drawn.Results In the sepsis group,spontaneous peritonitis(37 cases,55.22%)and lung infection(25 cases,37.31%)were the main causes.Among 25 patients with positive results for pathogenic culture,9(36.0%)were positive for Grain-positive bacteria and 16(64.0%)were positive for Gram-negative bacteria.Serum levels of sCD14-ST,PCT,CRP and NE in the sepsis group were significantly higher than those in the nonsepsis group(t=12.425,8.296,9.238 and 6.655,P all<0.05).Serum levels of sCD14-ST,PCT and CRP in the pathogen-positive group were significantly higher than those in pathogen-negative group(t=12.230.4.114 and 5.307,P all<0.05).Pearson correlation analysis showed that the serum sCD14-ST in the sepsis group was positively correlated with PCT and CRP(r=0.813 and 0.773,Pboth<0.01).The sensitivity and specificity of serum sCD14-ST,PCT and CRP combined detection were high(87.11%and 96.74%).The area under the ROC curve(AUC)of combined detection was 0.946.Conclusions The common infection sites of ACLF-based sepsis are abdominal cavity and lungs.Gram-negative bacteria are the main type of pathogens.Combined detection of serum sCD14-ST,PCT and CRP is helpful for early diagnosis of ACLF-based sepsis.

关 键 词：肝功能衰竭 脓毒症 sCD14-ST PCT CRP 早期诊断 联合检测 

分 类 号：R459.7[医药卫生—急诊医学] R575.3[医药卫生—治疗学]