人中性粒细胞载脂蛋白、降钙素原、白介素-6对危重患者发生导管相关性血流感染的早期诊断价值  

Early diagnostic value of human neutrophil lipocalin, procalcitonin and interleukin-6 in critical patients with catheter related bloodstream infection

作　　者：高菲 赵敏敏 李长秀 韩笑 刘蓓蓓 GAO Fei;ZHAO Minmin;LI Changxiu;HAN Xiao;LIU Beibei(ICU-1,the Second Affiliated Hospital of Shandong First Medical University,Shandong Province,Tai'an 271000,China;Comprehensive ICU-2,Tai'an Central Hospital,Shandong Province,Tai'an 271000,China)

机构地区：[1]山东第一医科大学第二附属医院ICU一区,山东泰安271000 [2]山东省泰安市中心医院综合ICU二区,山东泰安271000

出　　处：《中国当代医药》2024年第23期22-27,共6页China Modern Medicine

摘　　要：目的探讨人中性粒细胞载脂蛋白(HNL)、降钙素原(PCT)、白介素-6(IL-6)对长期留置中心静脉导管的危重患者发生导管相关性血流感染(CRBSI)的早期诊断价值。方法选取2022年1月至2023年9月山东第一医科大学第二附属医院重症医学科收治的189例留置中心静脉导管患者为研究对象,按照是否发生CRBSI分为CRBSI组(n=63)和非CRBSI组(n=126)。收集患者临床特征资料及留取血培养当天的HNL、PCT、IL-6结果。采用logistic回归分析建立HNL、PCT和IL-6的联合检测模型。采用受试者工作特征(ROC)曲线评价各项指标对危重患者发生CRBSI的早期诊断价值。结果CRBSI组HNL、PCT、IL-6水平均高于非CRBSI组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,HNL、PCT、IL-6及联合检测模型诊断CRBSI的ROC曲线下面积(AUC)分别为0.950、0.901、0.828、0.964,差异有统计学意义(P<0.05)。HNL、PCT、IL-6诊断CRBSI的最佳临界值分别为248.51 ng/ml、0.62 ng/ml、32.68 pg/ml,灵敏度分别为81.0%、79.4%、84.1%,特异度分别为99.2%、86.4%、69.6%。一致性检测结果显示,联合检测模型结果与预测诊断CRBSI存在较好的一致性(Kappa=0.810,P<0.05),HNL≥248.51 ng/ml与预测诊断CRBSI存在较好的一致性(Kappa=0.804,P<0.05)。结论相比于PCT、IL-6,HNL对危重患者发生导管相关性血流感染有较好的早期诊断价值。Objective To explore the early diagnostic value of human neutrophil lipocalin(HNL),procalcitonin(PCT)and interleukin-6(IL-6)for catheter related bloodstream infection(CRBSI)in critically ill patients with long-term central venous catheter indwelling.Methods A total of 189 patients with central venous catheterization admitted to the Department of Intensive Care Medicine of the Second Affiliated Hospital of Shandong First Medical University from January 2022 to September 2023 were selected as the study object and divided into CRBSI group(n=63)and non-CRBSI group(n=126)according to whether CRBSI occurred.Clinical characteristics of patients were collected and HNL,PCT,IL-6 results were collected on the day of blood culture.Logistic regression analysis was used to list the combined determination models of HNL,PCT and IL-6.Receiver operating characteristic(ROC)curve was ised to evaluate the early diagnosis value of each index in critically ill patients with CRBSI.Results The levels of HNL,PCT and IL-6 in CRBSI group were higher than those in non-CRBSI group,with statistical significances(P<0.05).ROC curve analysis showed that the area under ROC curve(AUC)of HNL,PCT,IL-6 and combined detection model for the diagnosis of CRBSI were 0.950,0.901,0.828 and 0.964,respectively,and the differences were statistically significant(P<0.05).The optimal cut-off points of HNL,PCT,IL-6 for the diagnosis of CRBSI were 248.51 ng/ml,0.62 ng/ml,32.68 pg/ml,with sensitivity of 81.0%,79.4%,84.1%,and specificity of 99.2%,86.4%,69.6%respectively.Consistency test results showed that the results of the combined detection model were in good agreement with the prediction of CRBSI diagnosis(Kappa=0.810,P<0.05),HNL≥248.51 ng/ml was in good agreement with the prediction of CRBSI diagnosis(Kappa=0.804,P<0.05).Conclusion Compared with PCT and IL-6,HNL has better value in early diagnosis of catheter related bloodstream infection in critically ill patients.

关 键 词：人中性粒细胞载脂蛋白 降钙素原 白介素-6 血流感染 导管相关性血流感染 

分 类 号：R44[医药卫生—诊断学]