降钙素原、白细胞介素6、sCD14、CD64检测在肝功能衰竭患者诊治中的临床研究
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摘要
目的研究降钙素原(PCT)、白细胞介素6(IL-6)、s CD14、CD64检测对肝功能衰竭诊治的临床价值。方法选取承德医学院附属医院收治的40例肝功能衰竭合并细菌感染患者(感染组)、40例肝功能衰竭不合并细菌感染患者(非感染组)及同期40例体检健康人员(对照组)。分别通过双抗夹心酶联免疫吸附试验检测、流式细胞仪检测研究对象血清PCT、IL-6、s CD14、CD64。根据患者转归结果分为治愈好转组与病死组,比较两组入院时血清PCT、IL-6、s CD14、CD64水平。通过受试者操作特征(ROC)曲线分析血清相关指标对肝功能衰竭合并细菌感染的诊断效能。结果与对照组比较,非感染组入院时血清PCT、IL-6、s CD14、CD64水平均升高(P <0.05);与非感染组比较,感染组患者入院时血清PCT、IL-6、s CD14、CD64水平均升高(P <0.05);感染组和非感染组患者治疗后血清PCT、IL-6、s CD14、CD64水平比治疗前均下降(P <0.05);感染组治愈好转率为55.00%,低于非感染组的77.50%,差异有统计学意义(P <0.05);与治愈好转组比较,病死组患者入院时血清PCT、IL-6、sCD14、CD64水平均升高(P<0.05);血清PCT、IL-6、sCD14、CD64诊断肝功能衰竭合并细菌感染曲线下面积(AUC)分别为0.596、0.700、0.642和0.618,敏感性分别为40.00%、69.16%、68.35%和53.50%,特异性分别为84.00%、78.27%、67.80%和77.35%。结论肝功能衰竭患者血清PCT、IL-6、sCD14、CD64水平均升高,其对肝功能衰竭合并细菌感染诊断有一定的价值,可作为患者预后转归评估有效指标。
Objective To study the clinical value of procalcitonin(PCT),interleukin-6(IL-6),sCD14 and CD64 in the diagnosis and treatment of liver failure.Methods Totally 80 liver failure patients admitted to the hospital during July 2015 to December 2017 were divided into with infection group and non-infection group based on occurrence of bacterial infection.Atotal of 40 healthy people served as control group.Patients were further subgrouped into recover group and death group.Serum PCT,IL-6,sCD14 and CD64 were measured by double-antibody sandwich enzyme-linked immunosorbent assay or flow cytometry.The diagnostic efficiency of serum markers for liver failure with bacterial infection was determined by receiver operating characteristic(ROC) curves.Results Levels of serum PCT,IL-6,sCD14 and CD64 were higher in the non-infection group compared with those in the control group(P<0.05),which were further enhanced significantly in the infection group when compared with those in non-infection group(P<0.05).Standard treatments induced dramatic decrease of serum PCT,IL-6,s CD14 and CD64 in both groups compared with those prior to any treatment(P<0.05).Patients in infection group experienced lower recovery rate compared with non-infection group(55.00% VS 77.50%,P<0.05).The levels of serum PCT,IL-6,sCD14 and CD64 were greatly upregulated in the death group than those in the recovery group(P<0.05).The areas under the curve(AUC) of serum PCT,IL-6,sCD14 and CD64 in diagnosis of liver failure with bacterial infection were 0.596,0.700,0.642 and 0.618,respectively.The sensitivity in diagnosis of liver failure with bacterial infection was 40.00%,69.16%,68.35% and 53.50%,respectively.Specificity in diagnosis of liver failure with bacterial infection was 84.00%,78.27%,67.80% and 77.35%,respectively.Conclusion The levels of serum PCT,IL-6,sCD14 and CD64 are increased in patients with liver failure,which may be diagnostic biomarkers of liver failure with bacterial infection.
Objective To study the clinical value of procalcitonin(PCT),interleukin-6(IL-6),sCD14 and CD64 in the diagnosis and treatment of liver failure.Methods Totally 80 liver failure patients admitted to the hospital during July 2015 to December 2017 were divided into with infection group and non-infection group based on occurrence of bacterial infection.Atotal of 40 healthy people served as control group.Patients were further subgrouped into recover group and death group.Serum PCT,IL-6,sCD14 and CD64 were measured by double-antibody sandwich enzyme-linked immunosorbent assay or flow cytometry.The diagnostic efficiency of serum markers for liver failure with bacterial infection was determined by receiver operating characteristic(ROC) curves.Results Levels of serum PCT,IL-6,sCD14 and CD64 were higher in the non-infection group compared with those in the control group(P<0.05),which were further enhanced significantly in the infection group when compared with those in non-infection group(P<0.05).Standard treatments induced dramatic decrease of serum PCT,IL-6,s CD14 and CD64 in both groups compared with those prior to any treatment(P<0.05).Patients in infection group experienced lower recovery rate compared with non-infection group(55.00% VS 77.50%,P<0.05).The levels of serum PCT,IL-6,sCD14 and CD64 were greatly upregulated in the death group than those in the recovery group(P<0.05).The areas under the curve(AUC) of serum PCT,IL-6,sCD14 and CD64 in diagnosis of liver failure with bacterial infection were 0.596,0.700,0.642 and 0.618,respectively.The sensitivity in diagnosis of liver failure with bacterial infection was 40.00%,69.16%,68.35% and 53.50%,respectively.Specificity in diagnosis of liver failure with bacterial infection was 84.00%,78.27%,67.80% and 77.35%,respectively.Conclusion The levels of serum PCT,IL-6,sCD14 and CD64 are increased in patients with liver failure,which may be diagnostic biomarkers of liver failure with bacterial infection.
引文
[1]曹竹君,谢青.慢加急性肝衰竭患者的感染问题:发生,特征及其对疾病进展和预后的影响[J].中华肝脏病杂志,2018,26(1):6-9.
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[9]JALAN R,GINES P,OLSON J C,et al.Acute-on chronic liver failure[J].Gastroenterol Hepatol,2012,57(6):1336-1348.
[10]ZHU Y,YUAN Y,HUANG H.Comparison of serum procalcitonin in respiratory infections and bloodstream infections[J].Int J Clin Exp Med,2016,8(11):21586-21592.
[11]JIN M,KHAN A I.Procalcitonin:uses in the clinical laboratory for the diagnosis of sepsis[J].Lab Med,2010,41(3):173-177.
[12]李小鹏,王亮,饶希,等.降钙素原,C-反应蛋白检测在肝衰竭合并腹腔感染中的临床价值[J].南昌大学学报(医学版),2017,57(5):33-35.
[13]邹美银,朱勇根,章幼奕,等.慢性乙型肝炎和肝衰竭患者血清IL-32,IL-6,IL-8检测及其意义[J].中华实验和临床病毒学杂志,2014,28(1):封2.
[14]AALTO H,TAKALA A,KAUTIAINEN H,et al.Monocyte CD14and soluble CD14 in predicting mortality of patients with severe community acquired infection[J].Seand J Infect Dis,2007,39(39):596-603.
[15]ANNUN ZIATAP,CIONIC,CAN TALUPOL,etal.Immunosuppressive monoclonal antibody to CD64 from patients with long-term stable multiple sclerosis[J].J Neuroimmunol,2013,256(1-2):62-70.
[16]LI X,WANG L K,WANG L W,et al.Cisplatin protects against acute liver failure by inhibiting nuclear HMGB1 release[J].Int JMol Sci,2013,14(6):11224-11237.
[17]LEI Y C,YANG L L,LI W,et al.Inhibition of sphingosine kinase 1 ameliorates acute liver failure by reducing high-mobility group box 1 cytoplasmic translocation in liver cells[J].World JGastroentero,2015,21(46):13055-13063.
[18]WEN Z M,LIU Y,LI F,et al.Circulating histones exacerbate inflammation in mice with acute liver failure[J].J Cell Biochem,2013,114(10):2384-2391.
[19]LAZZAROTTO C,RONSONI M F,FAYAD L,et al.Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis[J].Ann Hepatol,2013,12(4):599-607.
[20]CAI Z H,FAN C L,ZHENG J F,et al.Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J].BMC Infect Dis,2015,15(1):1-7.
[2]AGARWAL R,SCHWARTZ D N.Procalcitonin to guide duration of antimicrobial therapy in intensive care units:A systematic review[J].Clin Infect Dis,2011,53(4):379-387.
[3]王传敏,孟忠吉,陈悦,等.血清降钙素原检测对肝衰竭合并感染的早期诊断价值[J].临床肝胆病杂志,2017,33(6):1137-1140.
[4]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2012年版)[J].中华肝脏病杂志,2013,21(3):177-183.
[5]NOWLAN S,ARJUNA S,JULIA W,et al.Understanding infection susceptibility in patients with acute-on-chronic liver failure[J].Intens Care Med,2014,40(9):1363-1366.
[6]LEBER B,SPINDELBOECK W,STADLBAUER V.Infectious complications of acute and chronic liver disease[J].Semin Respir Crit Care Med,2012,33(1):80-95.
[7]WANG D W,YIN Y M,YAO Y M.Advances in the management of acute liver failure[J].World J Gastroentero,2013,19(41):7069-7077.
[8]ARAI M,KANDA T,YASUI S,et al.Opportunistic infection in patients with acute liver failure[J].Hepatol Int,2014,8(2):233-239.
[9]JALAN R,GINES P,OLSON J C,et al.Acute-on chronic liver failure[J].Gastroenterol Hepatol,2012,57(6):1336-1348.
[10]ZHU Y,YUAN Y,HUANG H.Comparison of serum procalcitonin in respiratory infections and bloodstream infections[J].Int J Clin Exp Med,2016,8(11):21586-21592.
[11]JIN M,KHAN A I.Procalcitonin:uses in the clinical laboratory for the diagnosis of sepsis[J].Lab Med,2010,41(3):173-177.
[12]李小鹏,王亮,饶希,等.降钙素原,C-反应蛋白检测在肝衰竭合并腹腔感染中的临床价值[J].南昌大学学报(医学版),2017,57(5):33-35.
[13]邹美银,朱勇根,章幼奕,等.慢性乙型肝炎和肝衰竭患者血清IL-32,IL-6,IL-8检测及其意义[J].中华实验和临床病毒学杂志,2014,28(1):封2.
[14]AALTO H,TAKALA A,KAUTIAINEN H,et al.Monocyte CD14and soluble CD14 in predicting mortality of patients with severe community acquired infection[J].Seand J Infect Dis,2007,39(39):596-603.
[15]ANNUN ZIATAP,CIONIC,CAN TALUPOL,etal.Immunosuppressive monoclonal antibody to CD64 from patients with long-term stable multiple sclerosis[J].J Neuroimmunol,2013,256(1-2):62-70.
[16]LI X,WANG L K,WANG L W,et al.Cisplatin protects against acute liver failure by inhibiting nuclear HMGB1 release[J].Int JMol Sci,2013,14(6):11224-11237.
[17]LEI Y C,YANG L L,LI W,et al.Inhibition of sphingosine kinase 1 ameliorates acute liver failure by reducing high-mobility group box 1 cytoplasmic translocation in liver cells[J].World JGastroentero,2015,21(46):13055-13063.
[18]WEN Z M,LIU Y,LI F,et al.Circulating histones exacerbate inflammation in mice with acute liver failure[J].J Cell Biochem,2013,114(10):2384-2391.
[19]LAZZAROTTO C,RONSONI M F,FAYAD L,et al.Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis[J].Ann Hepatol,2013,12(4):599-607.
[20]CAI Z H,FAN C L,ZHENG J F,et al.Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J].BMC Infect Dis,2015,15(1):1-7.
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