炎症相关标记物在鉴别重度腹腔感染不同细菌感染中的临床价值  

Clinical value of inflammation-related markers in differentiating bacterialinfections in severe abdominal infections

作　　者：朱甜天 康海全 薛婷 丁伟超 耿润露 燕宪亮 李腾腾 叶英 ZHU Tiantian;KANG Haiquan;XUE Ting;DING Weichao;GENG Runlu;YAN Xianliang;LI Tengteng;YE Ying(Department of Emergency Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004;Department of Clinical Examination,the Affiliated Hospital of Xuzhou Medical University;Jiangsu Provincial Institute of Health Emergency Response,Xuzhou,Jiangsu 221002;Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University)

机构地区：[1]徐州医科大学附属医院急诊医学科,江苏徐州221002 [2]徐州医科大学研究生院,江苏徐州221004 [3]徐州医科大学附属医院检验科 [4]江苏省卫生应急研究所,江苏徐州221002 [5]徐州医科大学附属医院普外科

出　　处：《徐州医科大学学报》2024年第12期894-898,共5页Journal of Xuzhou Medical University

基　　金：徐州市国家临床重点专科培育项目(2018ZK004);徐医附院优秀中青年人才项目(2019128009);国家重点研发计划子课题(2020YFC1512704);徐州市医学领军人才培养项目(XWRCHT20210026);“淮海经济区5G+区域一体化应急救治体系建设”工信化部和国家卫健委5G+医疗健康应用试点项目(2021年);江苏省基础研究计划(自然科学基金)面上项目(BK20231162)。

摘　　要：目的探讨白细胞介素(IL)-6、IL-10联合降钙素原(PCT)在重度腹腔感染患者细菌感染诊断中的价值。方法回顾性收集徐州医科大学附属医院2020年1月—2022年12月住院患者腹水培养阳性结果1993份。通过病历阅读,筛选出诊断重度腹腔感染患者的临床资料549份,根据病原菌分为革兰阳性(G+)菌组(n=304)和革兰阴性(G-)菌组(n=245),比较IL-6、IL-10和PCT在不同病原菌感染患者之间是否存在差异,评估其病原学诊断价值。结果使用IL-6、IL-10、PCT或三者联合预测G-菌阳性的ROC曲线下面积分别为0.851、0.835、0.769、0.904(P均<0.05)。用于预测G-菌阳性的IL-6阈值为176.32 ng/L,敏感度为72.2%,特异度87.5%;IL-10相应阈值为4.71 ng/L,敏感度为69.4%,特异度为84.5%;PCT相应阈值为3.03μg/L,敏感度为67.3%,特异度为74.7%;联合预测G-菌阳性的敏感度为91.4%,特异度为78.9%,小于阈值提示G+菌感染可能。结论IL-6、IL-10、PCT可用于鉴别重度腹腔感染患者早期G-或G+菌感染,联合预测的敏感度更高,有助于指导临床早期选择抗菌药物。Objective To explore the diagnostic value of interleukin(IL)-6,IL-10,and procalcitonin(PCT)in patients with severe abdominal infections due to bacterial pathogens.Methods A total of 1993 hospitalized patients with ascitic fluid culture-positive results at the Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2022 were enrolled and their clinical data were retrospectively analyzed.After medical record review,549 clinical cases of patients diagnosed with severe abdominal infections were selected.These cases were divided into two groups based on the causative pathogens:a Gram-positive(G+)bacteria group(n=245)and a Gram-negative(G-)bacteria group(n=304).Their differences in IL-6,IL-10,and PCT levels were analyzed,and the diagnostic value for identifying pathogens was evaluated.Results The area under the ROC curve(AUC)for predicting G-positive bacteria using IL-6,IL-10,PCT,or their combination was 0.851,0.835,0.769,and 0.904,respectively(all P<0.05).The threshold for predicting G-positive bacteria with IL-6 was 176.32 ng/L,with a sensitivity of 72.2%and a specificity of 87.5%;for IL-10,the threshold was 4.71 ng/L,with a sensitivity of 69.4%and specificity of 84.5%;for PCT,the threshold was 3. 03 μg/ L, with a sensitivity of 67. 3% and specificity of 74. 7%. The combined prediction of G- positive bacteriahad a sensitivity of 91. 4% and specificity of 78. 9%. Levels below these thresholds suggested a higher possibility of G+bacterial infections. Conclusions IL-6, IL-10, and PCT can be used to differentiate between early G- and G+ bacterialinfections in patients with severe abdominal infections. Combined prediction offers higher sensitivity and may help guidethe early selection of appropriate antimicrobial therapy in clinical practice.

关 键 词：腹腔感染 白细胞介素-6 白细胞介素-10 降钙素原 革兰阳性菌感染 革兰阴性菌感染 

分 类 号：R826.3[医药卫生—临床医学]