中性粒细胞CD64联合降钙素原对慢加急性肝衰竭合并细菌感染患者的诊断及预后评估价值

Clinical application value of nCD64 combined with PCT in patients complicated with acute-on-chronic liver failure and bacterial infection

目的探讨中性粒细胞CD64(neutrophil CD64,nCD64)联合降钙素原(procalcitonin,PCT)对乙型肝炎病毒(hepatitis B virus,HBV)相关慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)合并细菌感染的早期诊断及预后评估价值。方法选取2016年1月至2018年12月福建医科大学孟超肝胆医院住院的135例HBV相关ACLF患者,包括感染组94例及非感染组41例,根据感染组患者预后分为好转组及恶化组。流式细胞术及免疫化学发光法分别检测nCD64、PCT水平,采用受试者工作曲线(receiver operator characteristic curve,ROC曲线)分析它们对ACLF合并细菌感染的诊断及预后评估价值。结果(1)感染组nCD64、PCT水平均高于无感染组(均P <0.001)。(2)nCD64联合PCT诊断ACLF合并细菌感染的ROC曲线下面积(area under curve,AUC)高于单项nCD64、PCT,nCD64联合PCT对诊断ACLF合并细菌感染的敏感度、特异度、阴性预测值及准确度高于单项nCD64、PCT。(3)好转组nCD64、PCT水平低于恶化组(均P <0.001)。(4)nCD64联合PCT预测ACLF合并细菌感染患者恶化的AUC高于单项nCD64、PCT,nCD64联合PCT对评估ACLF合并细菌感染患者预后的敏感度、特异度、阳性预测值、阴性预测值及准确度均高于单项nCD64、PCT。结论 nCD64及PCT可作为HBV相关ACLF患者合并细菌感染的早期诊断及评估患者预后的参考指标,且两者联合效果更佳。

Objective To investigate the value of neutrophil CD64(nCD64)combined with procalcitonin(PCT)in diagnosis and prognosis of hepatitis B virus(HBV)associated acute-on-chronic liver failure(ACLF)patients complicated with bacterial infection. Methods One hundred and thirty-five patients with HBV-related ACLF were enrolled,dividing into infection group and non-infection group. Levels of nCD64 and PCT were detected by flow cytometry and immunochemiluminescence respectively. Results Levels of nCD64 and PCT in infection group were higher than those in non-infection group. The area under the ROC curve(AUC)of nCD64 combined with PCT for diagnosis of ACLF complicated with bacterial infection was higher than that of individual nCD64 and PCT(all P < 0.05). The sensitivity,specificity,negative prediction value and accuracy of nCD64 and PCT for diagnosis of ACLF with bacterial infection were higher than those of single nCD64 and PCT(all P < 0.05). Levels of nCD64 and PCT in improvement group were lower than those in deterioration group. The AUC of the combined nCD64 and PCT for forecast deterioration of ACLF complicated with bacterial infection was higher than that of nCD64 and PCT,respectively(all P < 0.05). The sensitivity,specificity,positive prediction value,negative prediction value and accuracy of nCD64 combined with PCT for diagnosis of ACLF with bacterial infection were higher than those of single nCD64 and PCT(all P < 0.05). Conclusion nCD64 and PCT are effective indicators for diagnosis and prognosis in HBV-related ACLF patients complicated with bacterial infection.