ESR、hs-CRP、IL-6、D-D对结核性多浆膜腔积液患者预后评估的价值  

Influencing factors and prognostic value of ESR,hs-CRP,IL-6 and D-D in patients with tuberculous polyserous effusion

作　　者：杨园园 王子云[1] 周忠 YANG Yuanyuan;WANG Ziyun;ZHOU Zhong(School of Public Health and Wellness,Guizhou Medical University,Guiyang 550025,China;Department of Respiratory and Critical Care,Guiyang Medical Center for Public Health)

机构地区：[1]贵州医科大学公共卫生与健康学院,550025 [2]贵阳市公共卫生救治中心呼吸与危重症科

出　　处：《天津医药》2023年第6期628-632,共5页Tianjin Medical Journal

基　　金：贵阳市科技局计划项目(筑科合同[2019]9-12-10号)。

摘　　要：目的探讨结核性多浆膜腔积液患者红细胞沉降率(ESR)、白细胞介素(IL)-6、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)对预后的评估价值。方法228例结核性多浆膜腔积液住院患者根据转归情况分为预后不良组(89例)和预后良好组(139例)。收集2组患者的基线资料、结核病情相关资料及在入院24 h内检测白细胞(WBC)、中性粒细胞比率(NEUT%)、ESR、血小板(PLT)、降钙素原(PCT)、hs-CRP、IL-6、血清白蛋白(ALB)、D-D。采用多因素Logistic回归分析结核性多浆膜腔积液住院患者预后不良的影响因素;受试者工作特征(ROC)曲线分析各指标对预后不良的诊断价值。结果预后不良组的NEUT%、ESR、hs-CRP、IL-6、D-D水平高于预后良好组(P<0.05)。ESR、hs-CRP、IL-6、D-D水平升高是结核性多浆膜腔积液住院患者预后不良的危险因素(P<0.05),建立联合预测模型为logit(P)=-6.650+0.050×(ESR)+0.008×(hs-CRP)+0.024×(IL-6)+0.251×(D-D)。ROC曲线分析显示在单项指标检测中,曲线下面积(AUC)最大的是ESR,为0.819(95%CI:0.766~0.873);多项指标联合检测中ESR+IL-6+hs-CRP+D-D四项指标联合检测时AUC为0.905(95%CI:0.865~0.945)。结论ESR、hs-CRP、IL-6、D-D联合检测对结核性多浆膜腔积液不良预后具有一定的预测价值。Objective To explore the influencing factors of prognostic value of erythrocyte sedimentation rate(ESR),interleukin(IL)-6,hypersensitive C-reactive protein(hs-CRP)and D-dimer(D-D)in patients with tuberculous polyserous effusion.Methods A total of 228 hospitalized patients with tuberculous polyserous effusion were collected and divided into the poor prognosis group(89 cases)and the good prognosis group(139 cases)according to the outcome.Baseline characteristics,tuberculosis disease related data and leukocyte(WBC),neutrophil ratio(neutrophil%),ESR,PLT,procalcitonin(PCT),hs-CRP,IL-6,serum albumin(ALB)and D-D were collected within 24 h after admission.Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in inpatients with tuberculous polyserous effusion.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of each indicator for poor prognosis.Results Levels of NEUT%,ESR,hs-CRP,IL-6 and D-D were significantly higher in the poor prognosis group than those in the good prognosis group(P<0.05).Increased levels of ESR,hs-CRP,IL-6 and D-D were risk factors for poor prognosis in inpatients with tuberculous polyserous effusion(P<0.05).The joint prediction model was established as logit(P)=-6.650+0.050×(ESR)+0.008×(hs-CRP)+0.024×(IL-6)+0.251×(D-D).ROC curve analysis showed that the largest area under the curve(AUC)was ESR,which was 0.819(95%CI:0.766-0.873).The AUC of ESR+IL-6+hs-CRP+D-D combined detection was 0.905(95%CI:0.865-0.945).Conclusion The combined detection of ESR,hs-CRP,IL-6 and D-D has a certain predictive value for the prognosis of tuberculous polyserous effusion.

关 键 词：结核 胸腔积液 血沉 C反应蛋白质 白细胞介素6 纤维蛋白纤维蛋白原降解物 预后 多浆膜腔积液 

分 类 号：R52[医药卫生—内科学]