血清降钙素原检测对早期诊断肝衰竭合并感染的临床意义

目的:探讨血清降钙素原(PCT)检测在肝衰竭合并感染早期诊断中的临床意义。方法:选择2014年3月至2017年3月我院收治的由病毒性肝炎导致的肝衰竭患者102例为研究对象,根据有无感染分为感染组(75例)和非感染组(27例),采用干式免疫荧光法检测其血清PCT水平,并检测两组患者白细胞(WBC)水平、C反应蛋白(CRP)水平、中性粒细胞百分比(N%),进行全身炎症反应综合征(SIRS)评分,采用多因素Logistic回归模型分析PCT、WBC、CRP、N%水平和SIRS评分对肝衰竭合并感染的预测价值大小,绘制受试者工作特征曲线(ROC曲线)评价PCT、WBC、CRP、N%水平和SIRS评分对肝衰竭合并感染的诊断价值。结果:感染组PCT、WBC、N%、CRP水平和SIRS评分均高于非感染组(P0.05);不同感染部位患者WBC、N%、CRP水平和SIRS评分比较差异不明显(P0.05);多部位感染患者血清PCT水平均高于其他单部位感染患者(P0.05);多因素Logistic回归分析显示,PCT和N%水平是肝衰竭合并感染的独立危险因素(P0.05);PCT、N%、CRP、WBC水平和SIRS评分诊断肝衰竭合并感染的ROC曲线下面积(AUC)值依次为0.916、0.763、0.752、0.746、0.682,PCT诊断肝衰竭合并感染的AUC值分别与N%、CRP、WBC和SIRS评分比较差异均有统计学意义(Z=3.518、3.672、4.103、5.106,P0.05)。结论:肝衰竭合并感染患者血清PCT水平明显升高,PCT对肝衰竭合并感染的诊断价值优于WBC、CRP、N%和SIRS评分等传统实验室指标。

Clinical Significance of Serum Procalcitonin Detection in Early Diagnosis of Liver Failure Complicate with Infection

ABSTRACT Objective: To explore the clinical significance of serum procalcitonin (PCT) detection in the early diagnosis of liver failure complicate with infection. Methods: 102 patients with liver failure caused by viral hepatitis who were treated in our hospital from March 2014 to March 2017 were selected as the object, the patients were divided into infection group (75 cases) and non infection group (27 cases) according to whether or not they were infected, the level of serum PCT was detected by dry immunofluorescence method, the levels of white blood cell (WBC), C reactive protein (CRP) and neutrophil percentage (N%) were detected in the two groups, systemic in- flammatory response syndrome (SIRS) score was performed, multivariate logistic regression was used to analyze the predictive value of PCT, WBC, CRP, N% levels and SIRS scores in the diagnosis of liver failure complicated with infection, the receiver operating charac- teristic curve (ROC curve) was drawn to evaluate the diagnostic value of PCT, WBC, CRP, N% levels and SIRS scores in patients with liver failure complicated with infection. Results: The levels of PCT, WBC, N%, CRP and SIRS scores in the infection group were higher than those in the non infection group (P<0.05). There were no significant differences in WBC, N%, CRP levels and SIRS scores between different infection sites (P>0.05). Serum PCT levels in patients with multiple site infections were higher than those in other single site in- fections (P<0.05). Multivariate Logistic regression analysis showed that the levels of PCT and N% were independent risk factors for liver failure complicated with infection (P<0.05). The area under the ROC curve (AUC) of PCT, N%, CRP, WBC levels and SIRS scores were 0.916, 0.763, 0.752, 0.746 and 0.682 respectively for diagnosis of liver failure complicated with infection. The differences were statisti- cally significant between the AUC of PCT diagnosis of liver failure complicated with infection and the N%, CRP, WBC levels and SIRS scores (Z=3.518, 3.672, 4.103, 5.106, P<0.05). Conclusion: The level of serum PCT in patients with liver failure complicate with infec- tion is obviously higher, and the diagnostic value of PCT for liver failure complicate with infection is superior to the traditional laboratory indexes such as WBC, CRP, N% and SIRS score.