血清CRP、IL-6及PCT对胆道感染的诊断价值

Effect of serum CRP,IL-6,and PCT on diagnosis of biliary tract infections

目的探讨血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)和降钙素原(PCT)对胆道感染的诊断效果,为胆道感染早期诊断提供新的途径。方法选取2014年6月-2016年6月医院接受治疗的胆道感染患者103例为研究组,同期在医院做常规体检的健康者103例为对照组,比较两组受试者的一般资料、CRP、IL-6和PCT的含量,确定CRP、IL-6和PCT对胆道感染的曲线下面积(ROC)和诊断分界点,统计胆道感染的灵敏度、特异性、阳性与阴性的预测值,比较CRP、IL-6和PCT含量与病原微生物的关系。结果研究组总胆红素的含量显著高于对照组,差异有统计学意义(P<0.05);103例胆道感染患者共分离培养121株菌落,其中,革兰阴性菌79株占65.3%,以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主,革兰阳性菌19株占15.7%,以金黄色葡萄球菌为主,真菌23株占19.0%,以白假丝酵母菌为主;研究组受试者CRP、IL-6、PCT的含量显著高于对照组,且差异有统计学意义(P<0.05);3种炎性因子均对胆道感染具有较好的预测作用,其中IL-6的敏感性(94.2%)最强,CRP的特异性(80.6%)最强,PCT的阳性预测值(80.8%)最高,IL-6的阴性预测值(91.3%)最高;革兰阴性菌患者、革兰阳性菌患者以及真菌患者的CRP、IL-6和PCT的差异均无统计学意义。结论早期胆道感染患者的CRP、IL-6、PCT的含量显著提升,IL-6、PCT对于检测早期胆道感染属于敏感性较高的炎性指标,可以应用于早期胆道感染的辅助诊断,值得临床推广,不能作为胆道感染的确诊指标。

OBJECTIVE To explore the effect of serum C-reactive protein （CRP）, interleukin-6 （IL-6）, and procalcitonin （PCT） on diagnosis of biliary tract infection so as to offer new approach for early diagnosis of the biliary tract infection, METHODS A total of 103 patients with biliary tract infection who were treated in the hospital from Jun 2014 to Jun 2016 were chosen as the study group, meanwhile, 103 healthy people who received routine physical examination were set as the control group. The baseline data and levels of CRP, IL-6, and PCT were compared between the two groups of participants; the area under ROC curve and cutoff points of CRP, IL-6, and PCT in diagnosis of biliary tract infection were determlned; the sensitivity, specificity, positive predictive value, and negative predictive value in diagnosis of biliary tract infection were statistically analyzed; the relationship between the levels of CRP, IL-6, and PCT and the pathogenic microorganisms was observed. RESULTS The total bilirubin level of the study group was significantly higher than that of the control group（P〈0.05）. Totally 121 strains of pathogens were isolated from the 103 patients with biliary tract infection, including 79 （65.3 %） strains of gram-negative bacteria, 19 （15.7%） strains of gram-positive bacteria, and 23 （19.0%） strains of fungi; Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were dominant among the gram-negative bacteria; Staphylococcus aureus was the predominant species of the gram-positive bacteria; Candida albicans was dominant among the fungi. The levels of CRP, IL-6, and PCT of the study group were significantly higher than those of the control group（P〈0. 05）, All of the three types of inflammatory factors had favorable effect on prediction of the biliary tract infection, the sensitivity of the IL-6 was the highest （94.2%）, the specificity of the CRP was the highest （80.6%）, and the negative predictive value of the IL-6 was highest （91.3%）. There was no significant difference in the CRP, IL-6, or PCT level among the patients with gram-negative bacteria biliary tract infections, the patients with gram-positive bacteria biliary tract infection, and the patients with fungi biliary tract infections. CONCLUSION The levels of CRP, IL-6, and PCT of the patients with early biliary tract infections are remarkably elevated. The IL-6 and PCT are highly sensitive in diagnosis of the early biliary tract infections and can be used for auxiliary diagnosis of the early biliary tract infections, and they are worthy to be promoted in the hospital.