多指标联合检测在肝硬化合并感染诊断中的价值

Clinical values of multi-marker combined detection for early diagnosis of infection in patients with liver cirrhosis

目的 分析降钙素原（PCT）、白介素6（IL-6）、C-反应蛋白（CRP）、中性粒细胞CD64、白细胞计数（WBC）、中性粒细胞比例等多种指标联合检测诊断肝硬化患者合并感染的临床价值。方法 将肝硬化住院患者按照细菌培养结果和临床症状分为感染组和非感染组,血清PCT、IL-6采用化学发光分析仪进行检测,血清CRP采用生化分析仪进行检测,中性粒细胞CD64采用流式细胞分析仪进行检测,WBC和中性粒细胞比例采用全血细胞分析仪进行检测。数据采用logistic回归和受试者工作特征（ROC）曲线进行分析。结果 感染组各项指标均高于非感染组（P〈0.01）。Logistic回归分析结果表明PCT、IL-6和中性粒细胞CD64具有预测肝硬化合并感染的能力,其OR值分别为7.199（95%CI：2.180~23.771）、1.010（95%CI：1.002~1.017）和2.312（95%CI：1.485~3.600）;而CRP、WBC和中性粒细胞比例不具有预测价值。ROC曲线分析结果显示,PCT、IL-6和中性粒细胞CD64的曲线下面积（AUC）分别为0.791（95%CI：0.727~0.856）、0.762（95%CI：0.693~0.832）和0.884（95%CI：0.835~0.933）;三者联合检测的AUC为0.932（95%CI：0.897~0.967）,诊断准确率为86.9%。结论PCT、IL-6和中性粒细胞CD64可以作为诊断肝硬化合并感染的指标,三者联合检测能够提高临床诊断效率。

Objective To analyze the clinical values of combined detection of procalcitonin（PCT）,interleukin-6（IL-6）,C-reaction protein（CRP）,neutrophil CD64,white blood cell（WBC）count and neutrophil ratio for diagnosis of infection in patients with liver cirrhosis.Methods The hospitalized patients with liver cirrhosis were divided into the infection group and the non-infection group according to the bacterial culture and clinical symptoms.The serum levels of PCT and IL-6 were detected by Chemiluminescence immunoassay.The serum CRP was detected by biochemistry analyzer.The neutrophil CD64 was detected by flow cytometer,and WBC count and neutrophil ratio were detected by blood cell analyzer.The collected data were analyzed by logistic regression and receiver operating characteristic（ROC）curves.Results All the markers in the infection group were higher than those in the non-infection group（P〈0.01）.The results of logistic regression analysis showed that PCT,IL-6and neutrophil CD64 could predict the infection in patients with liver cirrhosis,with the odd ratio being 7.199（95%CI,2.180-23.771）,1.010（95%CI,1.002-1.017）and 2.312（95%CI,1.485-3.600）,respectively.However,CRP,WBC count and neutrophil ratio showed no predictive values.The ROC curves showed that the area under curves（AUC）of PCT,IL-6and neutrophil CD64 were 0.791（95%CI,0.727-0.856）,0.762（95%CI,0.693-0.832）and 0.884（95%CI,0.835-0.933）,respectively.The AUC of combined detection of the three markers was 0.932（95%CI,0.897-0.967）,with a diagnostic accuracy of 86.9%.Conclusion PCT,IL-6and neutrophil CD64 can predict infection in patients with liver cirrhosis,and combined detection of the three markers can improve the diagnostic efficiency.