细胞因子对继发性噬血细胞综合征和重型肝炎合并感染具有早期鉴别意义  

Clinical significance of cytokines in early differentiation of secondary hemophagocytic syndrome and severe hepatitis with infection

作　　者：刘薇[1] 张梦 徐欣 王洪武 吴迪 齐俊英[1] LIU Wei;ZHANG Meng;XU Xin;WANG Hong-wu;WU Di;QI Jun-ying(Infectious Disease Department,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院感染科,湖北武汉430030

出　　处：《内科急危重症杂志》2022年第1期24-27,49,共5页Journal of Critical Care In Internal Medicine

基　　金：国家自然科学基金项目(No:81700529)。

摘　　要：目的:评价细胞因子在早期诊断继发性噬血细胞综合征中的临床意义。方法:收集华中科技大学同济医学院附属同济医院2018年1月~2020年12月收治的50例继发性噬血细胞综合征患者(HLH组)及50例重型肝炎合并感染(重肝组)患者的临床资料,通过单因素及多因素二元Logistic回归分析法分析疾病的独立危险因素,并绘制受试者工作特征(ROC)曲线,分析其诊断价值。结果:HLH组的血细胞减少患者构成比、乳酸脱氢酶(LDH)、超敏C反应蛋白、铁蛋白、白细胞介素(IL)-2受体、IL-10和肿瘤坏死因子-α水平显著高于重肝组,IL-1β、IL-8水平明显低于重肝组(P均<0.05)。二元Logistic回归显示LDH、IL-2受体为独立危险因素,ROC曲线下面积(AUC)分别为0.910、0.908,当LDH≥398 U/L时,其诊断HLH的灵敏度为78%,特异度为93.9%;当IL-2受体≥2 861 U/mL时,其诊断HLH的灵敏度为78%,特异度为95.9%。联合细胞因子谱诊断时AUC为0.911,灵敏度为74%,特异度为100%。结论:在HLH早期,LDH、IL-2受体具有很高的诊断价值,且细胞因子谱在HLH及重型肝炎合并感染患者中的表现差别较大,联合诊断价值更高。Objective: To evaluate the clinical significance of cytokines in the early diagnosis of secondary hemophagocytic syndrome. Method: The clinical data of 50 patients with secondary hemophagocytic syndrome(HLH group) and 50 with severe hepatitis with infection(severe hepatitis with infection group) were collected from January 2018 to December 2020. The independent risk factors of HLH were analyzed by univariate and binary logistic regression analysis, and ROC curves were drawn to analyze the diagnostic value of them. Results: In HLH group, the levels of hematocytopenia, LDH, hs-CRP, SF, IL-2 R, IL-10 and TNF-α were significantly higher and the levels of IL-1β and IL-8 were obviously lower than those in control group(P<0.05). Binary logistic regression analysis showed that LDH and IL-2 R were independent risk factors of HLH and their AUC was 0.910 and 0.908 respectively. Patients whose LDH ≥398 U/L(sensitivity: 78%,specificity: 93.9%) or IL-2 R ≥ 2861 U/mL(sensitivity: 78%, specificity: 95.9%) had higher risk of HLH. The AUC of the joint detection of 5 cytokines was 0.911, sensitivity was 74%, specificity was 100%. Conclusions: In the early stage of HLH, LDH and IL-2 R have high diagnostic value. The expression of cytokines varies greatly in patients with HLH and severe hepatitis with infection, and the joint detection of cytokines has higher diagnostic value.

关 键 词：噬血细胞综合征 细胞因子 乳酸脱氢酶 早期诊断 

分 类 号：R575.1[医药卫生—消化系统]