TACE术治疗的原发性肝癌患者血清IL-33水平变化及其对发热的鉴别意义探讨

Predictive efficacy of serum IL-33 and procalcitonin levels for bacterial infection in primary liver cancer patients with fever after TACE

目的探讨血清白细胞介素-33(IL-33)预测经导管肝动脉化疗栓塞(TACE)术后发热的原发性肝癌(PLC)患者细菌感染的价值。方法2020年4月~2022年4月我院收治的PLC患者150例,均接受TACE治疗,术后发热。采用标本培养和影像学检查,综合判断细菌感染。采用ELISA法检测血清IL-33水平,常规检测降钙素原(PCT)。应用SPSS统计学软件绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),判断血清IL-33和PCT水平预测PLC患者细菌感染的效能。结果在本组PLC患者中,TACE术后发生细菌感染者50例(33.3%);细菌感染组基线糖尿病合并率、肿瘤TNMⅢ期、肿瘤大于5 cm和肿瘤多发占比显著高于非细菌感染组(P<0.05);细菌感染患者血清PCT和IL-33水平分别为(14.91±3.23)ng/mL和(42.2±8.5)pg/mL,显著高于非细菌感染患者【分别为(0.06±0.01)pg/mL和(13.4±4.9)pg/mL,P<0.05】;以血清PCT、IL-33水平和两者联合诊断细菌感染的AUC分别为0.869(95%CI=0.804~0.898,P<0.001)、0.786(95%CI=0.712~0.849,P<0.001)和0.895(95%CI=0.855~0.912,P<0.001),以联合诊断效能最优,其敏感度为0.770,特异度为0.930。结论监测血清IL-33和PCT水平可帮助诊断TACE术后发热的PLC患者细菌感染,值得开展扩大验证研究。

Objective The purpose of this study was to explore the predictive efficacy of serum interleukin-33(IL-33)and procalcitonin(PCT)levels for bacterial infection in primary liver cancer(PLC)patients with fever after transcatheter arterial chemoembolization(TACE).Methods A total of 150 patients with PLC were enrolled in our hospital between April 2020 and April 2022,and all patients underwent TACE.The bacterial infection was diagnosed based on blood routine,serology,imaging and bacterial characterization.Serum IL-33 level was detected by ELISA.The receiver operating characteristic(ROC)curves were drawn by SPSS statistical software and the diagnostic performance was analyzed by the area under the ROC curve(AUC).Results Out of the 150 patients with PLC,the bacterial infection was diagnosed in 50 cases(33.3%)after TACE;the incidence of diabetes,tumor in TNMⅢstage,the diameters of tumor greater than 5 cm and the multiple tumors in patients with bacterial infection were much higher than in patients without(P<0.05);serum PCT and IL-33 levels in patients with bacterial infection were(14.91±3.23)ng/mL and(42.2±8.5)pg/mL,significantly higher than[(0.06±0.01)pg/mL and(13.4±4.9)pg/mL,respectively,P<0.05]in patients without;the AUCs were 0.869(95%CI=0.804-0.898,P<0.001),0.786(95%CI=0.712-0.849,P<0.001)and 0.895(95%CI=0.855-0.912,P<0.001)when serum PCT,IL-33 levels and combination of the two parameters were applied to predict bacterial infection in PLC patients with fever after TACE,suggesting the combination superior to serum PCT or IL-33 alone(Z=1.784,P=0.074)as the combination having the sensitivity of 0.770 and the specificity of 0.930.Conclusion The increased serum IL-33 and PCT levels might hint the bacterial infection in PLC patients with fever after TACE,and warrants further clinical investigation.