外周血CD14^+CD16^+单核细胞亚群在肝衰竭继发感染患者中的检测价值

Detection value of CD14^+CD16^+monocyte subsets in peripheral blood in patients with secondary infection of liver failure

目的:探讨外周血CD14^+CD16^+单核细胞亚群在肝衰竭继发感染患者中的检测价值。方法:选择2015年3月~2018年4月我院住院的慢加急性肝衰竭患者156例,其中并发感染患者95例作为感染组,未并发感染患者61例作为未感染组;感染组95例患者中,将治疗后好转患者51例作为预后良好组,病情恶化自动出院或死亡患者44例作为预后不良组。检测并比较各组患者血清降钙素原(PCT)、TNF-α以及CD14^+CD16^+单核细胞亚群水平。结果:感染组患者血清PCT、TNF-α及CD14^+CD16^+水平均显著高于未感染组(P<0.05)。采用ROC曲线分析PCT、TNF-α及CD14^+CD16^+水平对肝衰竭感染的预测价值,曲线下面积分别为0.826(95%CI 0.768~0.905)、0.791(95%CI 0.71~0.863)、0.838(95%CI 0.791~0.926),最佳截断值分别为4.81、19.85、9.72。CD14^+CD16^+水平与PCT、TNF-α均呈显著正相关(P<0.05)。预后不良组患者血清PCT、TNF-α及CD14^+CD16^+水平均显著高于预后良好组(P<0.05)。采用ROC曲线分析PCT、TNF-α及CD14^+CD16^+水平对肝衰竭感染患者预后的预测价值,曲线下面积分别为0.789(95%CI 0.712~0.853)、0.769(95%CI 0.708~0.843)、0.802(95%CI 0.772~0.895),最佳截断值为5.40、24.25、12.02。结论:CD14^+CD16^+水平对肝衰竭患者并发感染具有着较高的临床诊断和预后预测价值,与机体炎症反应程度密切相关,可作为临床治疗监测指标之一,指导临床方案的拟定。

Objective:To explore the detection value of CD14^+CD16^+ monocyte subsets in peripheral blood in patients with secondary infection of liver failure.Methods:156 patients with acute-on-chronic liver failure hospitalized in our hospital from March 2015 to April 2018 were selected,including 95 patients with concurrent infection as infection group and 61 patients without concurrent infection as non-infection group.Among 95 patients in infection group,51 patients with improved treatment as good prognosis group,and 44 patients with deterioration of illness or death after treatment as poor prognosis group.The levels of serum procalcitonin(PCT),TNF-α and CD14^+CD16^+monocyte subsets were measured and compared in each group.Results:The levels of PCT,TNF-α and CD14^+CD16^+ in the infected group were significantly higher than those in the uninfected group(P<0.05).ROC curve was used to analyze the dectection value of PCT,TNF-α and CD14^+CD16^+for patients with infection,and the AUC were 0.826(95%CI 0.768-0.905),0.791(95%CI 0.71-0.863) and 0.838(95%CI 0.791-0.926),respectively,the cut-off were 4.81,19.85,9.72.The serum levels of PCT,TNF-α and CD14^+CD16^+ in patients with poor prognosis were significantly higher than those in patients with good prognosis(P<0.05).The ROC curve was used to analyze the prognostic value of PCT,TNF-α and CD14^+CD16^+levels for patients with hepatic failure infection.The AUC were 0.789(95%CI 0.712-0.853),0.769(95%CI 0.708-0.843) and 0.802(95%CI 0.772-0.895),respectively and the cut-off were 5.40,24.25 and 12.02.Conclusion:CD14^+CD16^+ level has high clinical diagnostic and prognostic value for patients with hepatic failure complicated with infection,and is closely related to the degree of inflammation.CD14^+ CD16^+ level can be used as one of the monitoring indicators for clinical treatment,and guide the formulation of clinical plans.