急诊血流感染患者肝功能指标相关分析

Correlation analysis of liver function indexes in patients with emergency bloodstream infection

目的评估常规肝功能生化检测作为急诊患者血流感染诊断的潜在指标。方法笔者收集了急诊115例血培养阳性并实验室证实的血流感染患者(实验组)和120例血培养阴性并细菌感染患者(对照组)。两组患者均无潜在肝胆疾病。对于实验组的患者,笔者分析了第一次血培养阳性当天的肝功能检查结果。对于对照组,在两对血培养瓶阴性血培养的第一天获得相同的数据。分别收集两组的肝功能指标ALT、AST、TBIL、DBIL、γ-GT、ALP、ChE及感染指标CRP并比较两组数据的相关性。结果经t检验,实验组血清ALT、AST、TBIL、DBIL、γ-GT、ALP水平显著高于对照组,而ChE水平显著低于对照组(P<0.05),作为感染指标的CRP两组却没明显差异(P>0.05)。多变量分析发现ChE是一个独立的因素,血清胆碱酯酶在ROC曲线下的面积(AUC)为0.748,而ALT、AST、TBIL、DBIL、γ-GT、ALP在ROC曲线下的面积(AUC)分别为:0.59、0.67、0.71、0.72、0.69、0.63。当血流感染时血清ALT、AST、TBIL、DBIL、γ-GT、ALP、ChE水平变化明显比非血流感染患者更快。结论急诊血流感染患者的ChE活性水平明显降低。ChE活性可作为快速诊断急诊患者血流感染的指标之一。

Objective The purpose of this study is to evaluate routine liver function biochemical testing as a potential indicator for the diagnosis of bloodstream infection in emergency patients.Methods 115 patients with positive blood culture and laboratory-confirmed bloodstream infection(experimental group)and 120 patients with negative blood culture and bacterial infection(control group)in the emergency department were collected.There was no underlying hepatobiliary disease in both groups.For patients in the experimental group,we analyzed the liver function test results on the day of the first positive blood culture.For the control group,the same data was obtained on the first day of the two pairs of blood culture bottles with negative blood culture.The liver function indexes ALT,AST,TBIL,DBIL,γ-GT,ALP,ChE and infection index CRP of the two groups were collected respectively,and the correlation between the two groups of data were compared.Results After t test,the serum ALT,AST,TBIL,DBIL,γ-GT and ALP levels of the experimental group were significantly higher than those of the control group,while the ChE level was significantly lower than that of the control group(P<0.05).There was no significant difference in CRP in the two groups as infection indicators(P>0.05).Multivariate analysis found that ChE was an independent factor.The area under the ROC curve(AUC)of serum cholinesterase was 0.748,while the area under the ROC curve(AUC)of ALT,AST,TBIL,DBIL,γ-GT,and(ALP)Are respectively:0.59,0.67,0.71,0.72,0.69,0.63.When the bloodstream was infected,the serum ALT,AST,TBIL,DBIL,γ-GT,ALP,and ChE levels change significantly faster than in patients with non-bloodstream infection.Conclusion The level of ChE activity in patients with emergency bloodstream infection was significantly reduced.ChE activity can be used as one of the indicators for rapid diagnosis of bloodstream infection in emergency patients.