CRP、PCT与中性粒细胞比率在乙肝相关性肝衰竭继发细菌感染患者中的临床意义

Clinical significance of CRP,PCT and neutrophil ratio in the patients with bacterial infection secondary to hepatitis B associated liver failure

目的探讨CRP、PCT与中性粒细胞比率在乙肝肝衰竭患者合并细菌感染中的诊断价值。方法研究对象为我院2017年1~12月收治的乙肝相关性肝衰竭患者80例,其中细菌培养阳性的患者设为感染组(n=40),排除合并感染者为非感染组(n=40),分别检测两组患者的血清C-反应蛋白、降钙素原、中性粒细胞比率,绘制ROC曲线,进行统计分析。结果感染组CRP、PCT、NEUT%比非感染组明显升高(P<0.05)。CRP曲线下面积ROC为0.829,95%CI(0.734,0.924);PCT曲线下面积ROC为0.820,95%CI(0.723,0.917);NEUT%曲线下面积ROC为0.863,95%CI(0.783,0.944)。当截断值为21.4 ng/mL,CRP的敏感度为72.5%,特异性为90.0%;当截断值为0.97 mg/L,PCT的敏感度为80.0%,特异性为80.0%。当截断值为76.4%,NEUT%的敏感度为75.0%,特异性为87.5%。结论 CRP、PCT、NEUT%为诊断乙肝肝衰竭合并感染的可靠指标,PCT敏感性较强,CRP特异性较高,综合分析有利于准确判断是否存在感染。

Objective To investigate the diagnostic value of CRP, PCT and neutrophil ratio in the patients with hepatitis B liver failure complicated with bacterial infection. Methods 80 patients with hepatitis B-associated liver failurewho were admitted to our hospital from January to December 2017 were selected as the study subjects. Patients withpositive bacterial culture were assigned to the infection group（n=40）, and the patients excluded from co-infection wereassigned to the non-infection group（n=40）. Serum C-reactive protein, procalcitonin, and neutrophil ratios were measured in the two groups of patients. The ROC curve was drawn for statistical analysis. Results The CRP, PCT andNEUT% in the infection group were significantly higher than those in the non-infection group （P〈0.05）. The area under the CRP curve （ROC） was 0.829, 95%CI（0.734, 0.924）; the area under the PCT curve（ROC） was 0.820, 95%CI（0.723, 0.917）; the area under the NEUT% curve（ROC） was 0.863, 95%CI（0.783, 0.944）. When the cutoff value was21.4 ng/mL, the sensitivity of CRP was 72.5% and the specificity was 90.0%; when the cutoff value was 0.97 mg/L, thesensitivity of PCT was 80.0% and the specificity was 80.0%. When the cutoff value was 76.4%, the sensitivity ofNEUT% was 75.0% and the specificity was 87.5%. Conclusion CRP, PCT and NEUT% are reliable indicators in thediagnosis of hepatitis B liver failure complicated with infection. PCT sensitivity is stronger and CRP specificity is higher.Comprehensive analysis is helpful to accurately determine whether there is an infection.