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

Prognostic significance of procalcitonin, Interleukin-6, sCD14 and CD64 in liver failure

摘要:

目的??研究降钙素原 （PCT） 、 白细胞介素 6 （IL-6） 、 sCD14、 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、sCD14、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、sCD14、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、sCD14、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、 sCD14、 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、sCD14、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。

Abstract:

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 sub- grouped 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, sCD14 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.