慢加急性乙型肝炎肝衰竭患者血清CRP和sTREM-1水平变化及其预测继发感染的价值研究  

Assessment of bacterial infection by serum CRP and sTREM-1 levels in patients with hepatitis B virus-associated acute-on-chronic liver failure

作　　者：柯海霞 张娇珍 蒙夏玲 许政衡 邓丕豪 Ke Haixia;Zhang Jiaozhen;Meng Xialing(Clinical Laboratory,Traditional Chinese Medicine Hospital,Haikou 570216,Hainan Province,China)

机构地区：[1]海口市中医医院检验科,570216 [2]海南医学院第一附属医院泌尿外科

出　　处：《实用肝脏病杂志》2024年第4期555-558,共4页Journal of Practical Hepatology

基　　金：海南省自然科学基金面上项目(编号:821MS168)。

摘　　要：目的探讨应用血清C反应蛋白(CRP)联合可溶性髓系细胞触发受体-1(sTREM-1)水平判断慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者继发感染的效能。方法2020年2月~2023年2月我院诊治的HBV-ACLF患者96例,采用ELISA法检测血清CRP和sTREM-1,应用多因素Logistic回归分析HBV-ACLF患者继发感染的影响因子,绘制受试者工作特性曲线(ROC)评估指标的诊断效能。结果在本组纳入的96例HBV-ACLF患者中,继发感染67例(69.8%),其中自发性细菌性腹膜炎占40.3%,肺部感染占31.3%,泌尿道感染占11.9%,胆道感染和肠道感染各占4.5%,皮肤软组织感染占7.5%;感染组终末期肝病模型(MELD)和慢性肝衰竭-序贯器官衰竭评估模型评分(CLIF-SOFA)分别为(15.7±3.0)和(8.5±1.1)分,显著高于未感染组【分别为(12.40±3.00)和(6.1±1.0),P<0.05】;感染组CRP和sTREM-1水平分别为(52.2±4.6)mg/L和(29.9±5.8)pg/mL,显著高于未感染组【分别为(10.1±3.3)mg/L和(13.3±4.1)pg/mL,P<0.05】;Logistic回归分析显示,INR、CRP、sTREM-1和降钙素原(PCT)均为影响HBV-ACLF患者继发感染的独立危险因子(P<0.05);ROC曲线分析显示,血清CRP联合sTREM-1水平诊断HBV-ACLF患者继发感染的AUC为0.906,其灵敏度和特异度分别为98.5%和82.8%,显著优于两指标单独诊断(P<0.05)。结论应用血清CRP和sTREM-1联合检测可辅助诊断HBV-ACLF患者继发感染的存在,具有一定的临床价值。Objective The purpose of this study was to investigate the diagnostic efficacy of serum C-reactive protein(CRP)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)levels for secondary infections in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF).Methods 96 consecutive patients with HBV-ACLF were encountered in our hospital between February 2020 and February 2023.Serum CRP and sTREM-1 levels were measured by ELISA.The multivariate Logistic regression analysis was conducted to identify the influencing factors for secondary infections in patients with HBV-ACLF.The diagnostic performance of above parameters was evaluated by using the receiver operating characteristic(ROC)curve.Results 67(69.8%)patients with HBV-ACLF in our series developed secondary infections,and the spontaneous bacterial peritonitis,pulmonary infection,urinary tract infection,biliary tract infection,intestinal infection,and skin and soft tissue infection accounted for 40.3%,31.3%,11.9%,4.5%,4.5%,and 7.5%,respectively;the model of end-stage liver disease score and chronic liver failure sequential organ failure assessment score in patients with infection were(15.7±3.0)and(8.5±1.1),both significantly greater than[(12.40±3.00)and(6.1±1.0),P<0.05]in patients without infection;serum CRP and sTREM-1 levels in patients with infection were(52.2±4.6)mg/L and(29.9±5.8)pg/mL,both much higher than[(10.1±3.3)mg/L and(13.3±4.1)pg/mL,P<0.05]in those without;the Logistic regression analysis showed that the international normalization ratio,serum CRP,sTREM-1 and procalcitonin levels were all the independent risk factors for secondary infection(P<0.05);the ROC analysis demonstrated that the AUC was 0.906,with the sensitivity of 98.5%and the specificity of 82.8%,when serum CRP and sTREM-1 level combination was applied to predict the existence of infection,much superior to any parameter alone(P<0.05).Conclusion The surveillance of serum CRP and sTREM-1 level could help diagnose the secondary infections in pat

关 键 词：慢加急性肝衰竭 C反应蛋白 可溶性髓系细胞触发受体-1 感染 诊断 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]