C反应蛋白、降钙素原和血小板计数联合检测对细菌性肝脓肿预后的预测价值

Predictive value of combined detection of C-reactive protein,procalcitonin and platelet count in the prognosis of pyogenic liver abscess

目的探讨C反应蛋白(CRP)、降钙素原(PCT)和血小板计数(PLT)联合检测对细菌性肝脓肿(PLA)预后的预测价值。方法选择2019年6月至2021年12月在南京市中医院接受治疗的98例PLA患者为研究对象。根据临床症状、血清学、影像学等结果将患者分为轻症组(n=29)和中重症组(n=69),根据患者的预后分为预后良好组(n=67)和预后不良组(n=31)。另选择40名同期在本院体检健康者为对照组。采集所有受试者空腹静脉血10 mL,采用全自动免疫发光分析仪检测血清CRP、PLT水平,采用双抗夹心免疫化学发光法检测血清PCT水平。收集所有患者的临床资料,采用单因素和多因素logistic回归分析影响PLA患者预后的危险因素,绘制受试者操作特征(ROC)曲线分析血清CRP、PCT、PLT对PLA患者预后的预测价值。结果轻症组、中重症组患者血清CRP、PCT、PLT水平显著高于对照组(P<0.05);中重症组患者血清CRP、PCT、PLT水平显著高于轻症组(P<0.05)。单因素分析结果显示,预后良好组与预后不良组患者的性别、最高体温、脓肿位置、腹部手术史、合并高血压比例及合并慢性阻塞性肺疾病比例比较差异无统计学意义(P>0.05);预后不良组与预后良好组患者的年龄、退热时间、脓肿数量、治疗方式、住院时间、合并糖尿病比例及血清CRP、PCT、PLT、丙氨酸转氨酶、谷氨酰转移酶、去甲肾上腺素水平比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示,CRP、PCT、PLT、去甲肾上腺素水平高及脓肿数量多、年龄大、糖尿病是影响PLA患者预后的不良因素(P<0.05)。ROC曲线结果显示,CRP预测PLA预后的曲线下面积(AUC)为0.612,敏感度为76.27%,特异度为69.23%;PCT预测PLA预后的AUC为0.637,敏感度为74.14%,特异度为67.50%;PLT预测PLA预后的AUC为0.665,敏感度为78.33%,特异度为71.05%;CRP、PCT、PLT联合检测预测PLA预后的AUC为0.815,敏感度为97.33%,特异度为91.30%。CRP、PCT、PLT联合检测预测PLA预后的敏感度和特异度均显著高于血清CRP、PCT、PLT单独检测(P<0.05)。进一步行亚组分析显示,CRP、PCT、PLT联合检测预测轻症、中重症PLA患者预后的敏感度和特异度均显著高于血清CRP、PCT、PLT单独检测(P<0.05)。结论PLA患者血清中CRP、PCT、PLT水平高于健康人群,三者均是影响患者预后的不良因素,且三者联合检测预测PLA患者预后的效能高于三者单独检测。

Objective To explore the predictive value of combined detection of C-reactive protein(CRP),procalcitonin(PCT)and platelet count(PLT)in the prognosis of pyogenic liver abscess(PLA).Methods A total of 98 PLA patients admitted to the Nanjing Hospital of Traditional Chinese Medicine from June 2019 to December 2021 were selected as the research objects.The patients were divided into mild group(n=29)and moderate and severe group(n=69)according to clinical symptoms,serology and imaging results;and they were divided into good prognosis group(n=67)and poor prognosis group(n=31)according to the prognosis.Another 40 healthy people who admitted to the hospital for physical examination during the same period were included as the control group.The 10 mL fasting venous blood of all subjects was collected,and the serum CRP,PLT levels of all subjects were detected by automatic immunoluminescence analyzer,the serum PCT levels of all subjects were detected by double antibody sandwich immunochemiluminescence method.The clinical data of all patients were collected and the risk factors affecting the prognosis of PLA were analyzed by logistic regression.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum levels of CRP,PCT and PLT in the prognosis of patients with PLA.Results The levels of CRP,PCT and PLT in serum of patients in the mild group,mode rate and severe group were significantly higher than those in the control group(P<0.05);the levels of CRP,PCT and PLT in serum of patients in the moderate and severe group were significantly higher than those in the mild group(P<0.05).The results of univariate analysis showed that there was no significant difference in the gender,maximum temperature,abscess location,abdominal surgery history,the proportion of combined with hypertension and the proportion of combined with chronic obstructive pulmonary disease of patients between the good prognosis group and poor prognosis group(P>0.05);there were significant differences in the age,antipyretic time,number of abscesses,treatment method,hospital stay,ratio of patients with diabetes and the serum CRP,PCT,PLT,alanine aminotransferase,glutamyltransferase,norepinephrine levels of patients between the poor prognosis group and the good prognosis group(P<0.05).Logistic regression analysis showed that the high levels of CRP,PCT,PLT and norepinephrine,a large number of abscesses,old age and diabetes were the risk factors affecting the prognosis of PLA patients(P<0.05).The ROC curve showed that the area under curve(AUC)of CRP in predicting the prognosis of PLA was 0.612,the sensitivity was 76.27%,the specificity was 69.23%;the AUC of PCT in predicting the prognosis of PLA was 0.637,the sensitivity was 74.14%,the specificity was 67.50%;the AUC of PLT in predicting the prognosis of PLA was 0.665,the sensitivity was 78.33%,the specificity was 71.05%;the AUC of combined detection of CRP,PCT and PLT in predicting the prognosis of PLA was 0.815,the sensitivity was 97.33%,the specificity was 91.30%.The sensitivity and specificity of combined detection of CRP,PCT and PLT in predicting the prognosis of PLA were significantly higher than those of single detection of serum CRP,PCT and PLT(P<0.05).Further subgroup analysis result showed that the sensitivity and specificity of the combined detection of CRP,PCT and PLT in predicting the prognosis of patients with mild,moderate and severe PLA were also significantly higher than those of single detection of serum CRP,PCT and PLT levels(P<0.05).Conclusion The levels of CRP,PCT and PLT in serum in patients with PLA are higher than those in healthy people,and they are poor prognostic factors of PLA patients.The efficacy of the combined detection of CRP,PCT and PLT are higher than single detection.