C反应蛋白/白蛋白比值、系统性免疫炎症指数对艾滋病机会性感染的预测价值  

Predictive value of C-reactive protein/albumin ratio and systemic immune-inflammation index for opportunistic infection among acquired immune deficiency syndrome patients

作　　者：杨贺乐 尹家海 邓小杰 Yang Hele;Yin Jiahai;Deng Xiaojie(Department of Laboratory Medicine,Honghu Center for Disease Control and Prevention,Honghu 433200,China)

机构地区：[1]洪湖市疾病预防控制中心检验科,洪湖433200

出　　处：《中国医师进修杂志》2023年第10期948-953,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨C反应蛋白/白蛋白比值(CAR)、系统性免疫炎症指数(SII)对艾滋病(AIDS)机会性感染的预测价值。方法回顾性选择2020年3月至2022年3月洪湖市疾病预防控制中心确诊的220例AIDS患者为研究对象,按照是否发生感染将患者分为机会性感染组(178例)和非机会性感染组(42例),再根据不同病原学检测结果将178例感染患者分为细菌感染组(22例)、真菌感染组(63例)和混合感染组(93例)。收集患者一般资料,根据实验室指标计算CAR和SII。采用Logistic回归筛选影响机会性感染或不同病原学感染的危险因素。采用受试者工作特征(ROC)曲线分析CAR、SII对机会性感染及不同病原学感染的预测价值。结果机会性感染组CD_(4)^(+)T细胞计数、淋巴细胞计数低于非机会性感染组,CRP、CAR、白细胞计数、中性粒细胞计数、SII高于非机会性感染组,差异有统计学意义(P<0.05)。多因素分析结果显示,CAR、SII是影响机会性感染的独立危险因素(P<0.05)。CAR预测机会性感染的曲线下面积(AUC)为0.886(95%CI 0.837~0.925),最佳临界值为0.46,特异度为97.0%,灵敏度为69.1%;SII预测机会性感染的AUC为0.743(95%CI 0.680~0.799),最佳临界值为375.85,特异度为52.4%,灵敏度为88.2%。Logistic回归分析结果显示,CAR、单核细胞计数、SII是ADIS患者细菌感染的独立危险因素(P<0.05),CAR、SII是ADIS患者真菌感染的独立危险因素(P<0.05),CD_(4)^(+)T细胞计数、CAR、SII是ADIS患者混合感染的独立危险因素(P<0.05)。CAR预测细菌感染、真菌感染、混合感染的AUC分别为0.898(95%CI 0.797~0.960)、0.828(95%CI 0.742~0.895)、0.923(95%CI 0.864~0.962),最佳临界值为0.49、0.43、0.40,特异度为98.7%、95.2%、92.9%,灵敏度为72.7%、66.7%、80.6%;SII预测细菌感染、真菌感染、混合感染的AUC分别为0.627(95%CI 0.497~0.744)、0.782(95%CI 0.633~0.811)、0.780(95%CI 0.700~0.847),最佳临界值为385.13、379.27、390.10,特异度为55.4%�Objective To explore the predictive value of C-reactive protein/albumin ratio(CAR)and systemic immune-inflammation index(SII)for opportunistic infection among acquired immune deficiency syndrome(AIDS)patients.Methods From March 2020 to March 2022,a total of 220 AIDS patients treated in Honghu Center for Disease Control and Prevention were enrolled and they were divided into opportunistic infection group(178 cases)and non-infection group(42 cases)according to whether infection occurred;they were also assigned to bacterial infection group(22 cases),fungal infection group(63 cases)and mixed infection group(93 cases)according to different etiological characteristics.The general data were collected and CAR,SII were calculated according to laboratory indicators.Logistic regression was used to screen the risk factors affecting opportunistic infections or different etiological infections.The predictive value of CAR and SII on opportunistic infection and different etiological infections were compared by using receiver operating characteristic(ROC)curve.Results The CD_(4)^(+)T cell count,lymphocyte count were lower in the opportunistic infection group and the CRP,CAR,white blood cell count,neutrophil count,SII were higher in the opportunistic infection group compared with non-infection group,there were statistical differences(P<0.05).The results of Logistic regression analysis showed that CAR and SII were the independent risk factors of opportunistic infection(P<0.05).The area under the curve(AUC)of CAR to predict opportunistic infection was 0.886(95%CI 0.837-0.925),the specificity and sensitivity was 97.0%and 69.1%;the AUC of SII to predict opportunistic infection was 0.743(95%CI 0.680-0.799),the specificity and sensitivity was 52.4%and 88.2%.The results of Logistic regression analysis showed that CAR,monocyte count and SII were the independent risk factors for bacterial infection(P<0.05).CAR and SII were the independent risk factors for fungal infection(P<0.05).CD_(4)^(+)T cell count,CAR and SII were the independent risk

关 键 词：艾滋病相关机会致病菌感染 C反应蛋白质 血清白蛋白 系统性免疫炎症指数 

分 类 号：R512.91[医药卫生—内科学]