血清IL-15、pro-ADM、MDH1对肝硬化伴上消化道出血患者细菌感染的预测价值

Predictive value of serum IL-15,pro-ADM and MDH1 for bacterial infection in patients with cirrhosis combined with upper gastrointestinal bleeding

目的探讨血清白细胞介素-15(IL-15)、肾上腺髓质素前体(pro-ADM)、苹果酸脱氢酶1(MDH1)对肝硬化伴上消化道出血患者细菌感染的预测价值。方法选取河北省开滦总医院2018年6月至2021年6月肝硬化伴上消化道出血患者118例,根据住院期间是否发生细菌感染分为感染组33例与未感染组85例,比较两组血清IL-15、pro-ADM、MDH1水平,分析各血清指标对肝硬化伴上消化道出血患者细菌感染的预测价值。结果感染组血清IL-15(262.59±36.52)ng/mL、pro-ADM(13.14±4.22)nmol/L、MDH1(627.36±201.78)mU/mL高于未感染组(224.83±27.94)ng/mL、(8.97±2.81)nmol/L、(445.21±142.30)mU/mL(P<0.05);Child-Pugh分级B级或C级患者血清IL-15(246.15±32.85)ng/mL、pro-ADM(10.99±3.09)nmol/L、MDH1(531.10±114.36)mU/mL高于A级患者(212.73±23.59)ng/mL、(8.35±2.26)nmol/L、(422.58±102.45)mU/mL(P<0.05);上消化道中重度出血患者血清IL-15(248.28±29.67)ng/mL、pro-ADM(11.19±2.58)nmol/L、MDH1(571.57±137.48)mU/mL高于轻度出血患者(221.60±21.51)ng/mL、(9.02±2.13)nmol/L、(415.44±113.29)mU/mL(P<0.05);APACHEⅡ评分>21分患者血清IL-15(251.83±31.42)ng/mL、pro-ADM(11.48±2.97)nmol/L、MDH1(563.57±148.22)mU/mL高于≤21分患者(212.24±20.66)ng/mL、(8.26±2.05)nmol/L、(401.21±109.63)mU/mL(P<0.05)。Pearson相关性分析,血清IL-15、pro-ADM、MDH1与Child-Pugh分级、上消化道出血严重程度、APACHEⅡ评分呈正相关(P<0.05);logistic回归分析,校正其他因素前后,血清IL-15、pro-ADM、MDH1均与肝硬化伴上消化道出血患者细菌感染独立相关(P<0.05);ROC曲线分析,血清IL-15、pro-ADM、MDH1联合预测肝硬化伴上消化道出血患者细菌感染的AUC为0.931(95%CI:0.869~0.970),特异度为90.91%,敏感度为80.95%,优于各指标单独预测0.844(95%CI:0.765~0.904)、0.737(95%CI:0.648~0.814)、0.744(95%CI:0.655~0.820)。结论血清IL-15、pro-ADM、MDH1可作为肝硬化伴上消化道出血患者细菌感染的预测指标,联合预测价值更为可靠,能为临床防治此类患者并发细菌感染提供有效信息。

Objective To investigate the predictive value of serum interleukin-15(IL-15),adrenomedullin precursor(pro-ADM),and malate dehydrogenase 1(MDH1)for bacterial infection in patients with cirrhosis and upper gastrointestinal bleeding.Methods A total of 118 patients with liver cirrhosis and upper gastrointestinal bleeding admitted to our hospital from June 2018 to June 2021 were selected as the research subjects.They were divided into infection group(33 cases)and non-infection group(85 cases)according to whether bacterial infection occurred during hospitalization.The clinical data including the levels of serum IL-15,pro-ADM and MDH1 between the 2 groups were compared,and the predictive value of various serum indicators for bacterial infection in patients with cirrhosis with upper gastrointestinal bleeding were analyzed.Results Serum IL-15(262.59±36.52)ng/mL,pro-ADM(13.14±4.22)nmol/L and MDH1(627.36±201.78)mU/mL in the infected group were higher than those in the uninfected group[(224.83±27.94)ng/mL,(8.97±2.81)nmol/L,(445.21±142.30)mU/mL],(P<0.05).Serum IL-15(246.15±32.85)ng/mL,pro-ADM(10.99±3.09)nmol/L,MDH1(531.10±114.36)mU/mL in patients with Child-Pugh classification B or C were higher than those in patients with class A[(212.73±23.59)ng/mL,(8.35±2.26)nmol/L,(422.58±102.45)mU/mL],(P<0.05).Serum IL-15(248.28±29.67)ng/mL,pro-ADM(11.19±2.58)nmol/L,MDH1(571.57±137.48)mU/mL in patients with moderate to severe upper gastrointestinal bleeding were higher than those in patients with mild bleeding[(221.60±21.51)ng/mL,(9.02±2.13)nmol/L,(415.44±113.29)mU/mL],(P<0.05).Serum IL-15(251.83±31.42)ng/mL,pro-ADM(11.48±2.97)nmol/L,MDH1(563.57±148.22)mU/mLin patients with APACHE II score>21 were higher than those in in patients with score≤21[(212.24±20.66)ng/mL,(8.26±2.05)nmol/L,(401.21±109.63)mU/mL],(P<0.05).The results of pearson correlation analysis showed that serum IL-15,pro-ADM,and MDH1 were positively correlated with Child-Pugh classification,severity of upper gastrointestinal bleeding,and APACHE II score(P<0.05).The rusults of logistic regression analysis showed that serum IL-15,pro-ADM,and MDH1 were independently associated with bacterial infection in patients with cirrhosis with upper gastrointestinal bleeding before and after correction for other factors(P<0.05).In ROC curve analysis,the AUC of the combination of serum IL-15,pro-ADM and MDH1 in predicting bacterial infection in patients with cirrhosis and upper gastrointestinal bleeding was 0.931(95%CI:0.869-0.970,specificity 90.91%,sensitivity 80.95%),which was better than the predictive value of each index alone 0.844(95%CI:0.765 to 0.904),0.737(95%CI:0.648 to 0.814)and 0.744(95%CI:0.655 to 0.820).Conclusion Serum IL-15,pro-ADM,and MDH1 can be used as predictors of bacterial infection in patients with cirrhosis and upper gastrointestinal bleeding,and the combined predictive value is more reliable and can provide effective information for clinical prevention and treatment of concurrent bacterial infection in such patients.