化脓性肝脓肿并发脓毒症的影响因素及其检查评估  

Influencing factors for sepsis in patients with suppurative liver abscess and assessment of test indexes

作　　者：赵豹 邬路平 徐乐珍 侯祝强 叶青青 叶传龙 ZHAO Bao;WU Lu-ping;XU Le-zhen;HOU Zhu-qiang;YE Qing-qing;YE Chuan-long(Second People′s Hospital of Yueqing City,Yueqing,Zhejiang 325608,China)

机构地区：[1]乐清市第二人民医院急诊内科,浙江乐清325608

出　　处：《中华医院感染学杂志》2021年第20期3069-3072,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划重点基金资助项目(2018ZDA13321)。

摘　　要：目的探究早期血清降钙素原(PCT)、高迁移率族蛋白-1(HMGB1)、肝羧酸酯酶-1(hCE-1)对化脓性肝脓肿(PLA)患者并发脓毒症的评估价值及其影响因素。方法选取2017年1月-2019年7月乐清市第二人民医院收治的PLA患者120例,将发生脓毒症患者作为研究组(n=29),未发生脓毒症患者作为对照组(n=91)。对两组患者的白细胞计数、中性粒细胞百分比、C-反应蛋白(CRP)、PCT、HMGB1水平、hCE1活性水平进行比较;对血清PCT、HMGB1、hCE1活性以及三者联合在评估PLA患者发生脓毒症的受试者工作特征(ROC)曲线进行分析;归纳PLA患者发生脓毒症的影响因素。结果研究组住院时间、糖尿病占比、白细胞计数、中性粒细胞百分比、CRP、PCT以及HMGB1水平高于对照组,而研究组患者的hCE1活性低于对照组(P<0.05)。PCT(趋高)(OR=1.296)、HMGB1(趋高)(OR=2.726)、hCE1活性(趋低)(OR=2.404)是PLA患者并发脓毒症的影响因素(P<0.05)。PCT、HMGB1、hCE1活性等3指标对PLA患者发生脓毒症的评估价值:AUC分别为0.701、0.736、0.732。联合应用价值更高:AUC为0.844。29例并发脓毒症的患者,死亡8例。死亡患者血清的PCT、HMGB1水平均高于存活患者,而死亡患者的hCE1活性低于存活患者(P<0.05)。结论 CRP、PCT、HMGB1、hCE-1水平,均与PLA患者发生脓毒症有密切关系。血清PCT、HMGB1以及hCE1均能对脓毒症有一定的预测价值,三者联合使用时对其发生的预测价值更高。OBJECTIVE To explore the evaluation value of early serum procalcitonin(PCT),high mobility group protein-1(HMGB1),liver carboxylesterase-1(hCE-1) in patients with suppurative liver abscess(PLA) complicated with sepsis and its influencing factors.METHODS A total of 120 PLA patients admitted to the Second People′s Hospital of Yueqing City from Jan.2017 to Jul.2019 were selected.Patients with sepsis were selected as the study group(n=29),and patients without sepsis were used as the control group(n=91).The white blood cell count,percentage of neutrophils,C-reactive protein(CRP),PCT,HMGB1 levels,and hCE1 activity levels were compared between the two groups of patients.The receiver operating curve(ROC) of serum PCT,HMGB,hCE1 activities and the combination of the three in evaluating the occurrence of sepsis in PLA patients were analyzed.The influencing factors of the occurrence of sepsis in PLA patients were summarized.RESULTS The hospital stay,the proportion of diabetes,white blood cell count,neutrophil percentage,CRP,PCT and HMGB1 levels of the study group were significantly higher than those of the control group,while the hCE1 activity of the study group was significantly lower than that of the control group(P<0.05).PCT(increasing)(OR=1.296),HMGB1(increasing)(OR=2.276),hCE1 activity(lowering)(OR=2.404) were the influencing factors of sepsis in patients with PLA Factors(P<0.05).The AUC of PCT,HMGB1,hCE1 activity and other three indicators in assessing the occurrence of sepsis in PLA patients were 0.701,0.736,and 0.732,respectively.The combined application value was more valuable,and its AUC was 0.844.Of the 29 patients with sepsis,8 died.The serum PCT and HMGB1 levels of the dead patients were significantly higher than those of the surviving patients,while the hCE1 activity of the dead group was significantly lower than that of the surviving group(P<0.05).CONCLUSION The CRP,PCT,HNGB1,hCE levels,etc.,were closely related to the occurrence of sepsis in PLA patients.Serum PCT,HMGB1 and hCE1 had a certain predictive valu

关 键 词：化脓性肝脓肿 脓毒症 降钙素原 高迁移率族蛋白-1 肝羧酸酯酶-1 

分 类 号：R459.7[医药卫生—急诊医学]