血清PCT和HBP及pro-ADM水平对乙型肝炎病毒相关慢加急性肝衰竭并发细菌感染的诊断价值  

Diagnostic value of serum PCT,HBP and pro⁃ADM in hepatitis B virus⁃acute⁃on⁃chronic liver failure complicated by bacterial infection

作　　者：熊玮[1] 余乐兰[1] 唐淑亚 XIONG Wei;YU Lelan;TANG Shuya(Department of Infectious Disease,Guizhou Aerospace Hospital,Zunyi,Guizhou 563003,China)

机构地区：[1]贵州航天医院感染科,贵州遵义563003

出　　处：《热带医学杂志》2024年第2期192-197,共6页Journal of Tropical Medicine

基　　金：2020年贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-115)。

摘　　要：目的探讨血清降钙素原(PCT)、肝素结合蛋白(HBP)、肾上腺髓质素前体(pro-ADM)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)并发细菌感染的诊断价值和预后预测效能。方法选取2020年1月-2022年1月贵州航天医院收治的163例HBV-ACLF患者,根据是否并发细菌感染分为细菌感染组92例和非细菌感染组71例,根据90 d预后将细菌感染组分为死亡亚组49例和存活亚组43例。收集患者临床资料,检测血清PCT、HBP、proADM水平。采用多因素logistic回归分析各项指标和HBV-ACLF并发细菌感染患者预后不良的关系,受试者工作特征(ROC)曲线分析血清PCT、HBP、pro-ADM水平诊断HBV-ACLF并发细菌感染的价值,及对HBV-ACLF并发细菌感染患者预后不良的预测效能。结果细菌感染组血清PCT、HBP、pro-ADM水平高于非细菌感染组,差异均有统计学意义(U=3.413、3.723、2.878,P均<0.05)。死亡亚组血清PCT、HBP、pro-ADM水平高于存活亚组,差异均有统计学意义(U=3.665、3.595、3.788,P均<0.05)。血清PCT、HBP、pro-ADM和HBV-ACLF并发细菌感染患者预后不良密切关联(P<0.05)。血清PCT、HBP、pro-ADM水平联合诊断HBV-ACLF并发细菌感染的曲线下面积(AUC)大于各指标单独诊断;血清PCT、HBP、pro-ADM水平联合预测HBV-ACLF并发细菌感染患者预后不良的AUC大于各指标单独预测和Child-Pugh评分、终末期肝病模型评分预测。结论血清PCT、HBP、pro-ADM水平升高和HBV-ACLF并发细菌感染患者预后不良密切关联,血清PCT、HBP、pro-ADM水平联合检测对HBV-ACLF并发细菌感染的诊断价值和预后预测效能较高。Objective To investigate the diagnostic value and prognostic prediction efficacy of serum procalcitonin(PCT),heparin⁃binding protein(HBP)and pro⁃adrenomedullin(pro⁃ADM)in hepatitis B virus⁃acute⁃on⁃chronic liver failure(HBV⁃ACLF)complicated with bacterial infection.Methods 163 patients with HBV⁃ACLF who were admitted to the Guizhou Aerospace Hospital from January 2020 to January 2022 were selected,and they were divided into 92 cases in the bacterial infection group and 71 cases in the non⁃bacterial infection group according to whether they had complicated with bacterial infection,and the bacterial infection group was divided into 49 cases in the death subgroup and 43 cases in the survival subgroup according to the 90 d prognosis.Clinical data were collected from patients,and serum PCT,HBP and pro⁃ADM levels were measured.Univariate and multivariate logistic regression were used to analyze the correlation between various indicators and the poor prognosis of patients with HBV⁃ACLF complicated with bacterial infection.The receiver operating characteristic(ROC)curve was used to analyze the value of serum PCT,HBP,pro⁃ADM levels in diagnosing HBV⁃ACLF complicated with bacterial infection,and the predictive efficacy of the poor prognosis of patients with HBV⁃ACLF complicated with bacterial infection.Results Serum PCT,HBP and pro⁃ADM levels were higher in the bacterially infected group than those in the non⁃bacterially infected group(U=3.413,3.723,2.878;all P<0.05).Serum PCT,HBP and pro⁃ADM levels were higher in the death subgroup than those in the survival subgroup(U=3.665,3.595,3.788;all P<0.05).Serum PCT,HBP,pro⁃ADM were strongly associated with poor prognosis in HBV⁃ACLF patients complicated with bacterial infection(P<0.05).The area under the curve(AUC)of the combined serum PCT,HBP and pro⁃ADM levels for the diagnosis of HBV⁃ACLF complicated by bacterial infection was greater than that of each indicator alone;the AUC of the combined serum PCT,HBP and pro⁃ADM levels for pred

关 键 词：乙型肝炎病毒 慢加急性肝衰竭 细菌感染 降钙素原 肝素结合蛋白 肾上腺髓质素前体 

分 类 号：R512.62[医药卫生—内科学]