恙虫病肝功能损害的炎症指标特点及危险因素分析

Inflammatory markers and risk factors for hepatic dysfunction in scrub typhus

目的探讨恙虫病并发肝功能损害患者的炎症指标特点及中重度肝损害肝功能损害危险因素。方法选取2016年01月—2020年12月南京鼓楼医院集团宿迁医院我院住院且出院诊断恙虫病的143例患者为研究对象,根据肝功能水平分为肝功能正常组、轻度肝功能损害组、中重度肝功能损害组。分析血常规、生化等指标在恙虫病患者中的改变;对具有统计学意义的项目进行多元Logisticlogistic回归分析,并对独立危险因素的预测价值进行分析。结果恙虫病患者肝功能正常组、肝功能轻度损害组、肝功能中重度损害组中患者的性别(13/19,16/32,17/46,χ^(2)=1.855)、年龄(58.22±9.58,56.85±13.54,53.14±12.44,χ^(2)=5.667)及患病时间差异(6.66±2.57,7.19±3.23,7.98±3.59,χ^(2)=4.244)无统计学意义差异(P>0.05),生化指标中的总胆红素水平[(11.12±5.66),(12.77±12.55),(10.78±3.93)μmol/L,χ^(2)=0.226]差异也无统计学意义差异(P>0.05)。肝功能中重度损害组患者的住院时间[(12.67±5.25)d]、淋巴细胞计数[(3.19±1.51)×10^(9)/L]、谷丙转氨丙氨酸氨基转移酶[(190.945±97.66)U/L]、谷草转氨天冬氨酸氨基转移酶[(142.24±95.94)U/L]、谷氨酰转肽酶[(152.38±133.05)U/L])、碱性磷酸酶[(144.96±82.29)U/L]、β2微球蛋白(7.17±9.13)mg/L、纤维蛋白原[(3.60±0.54)g/L]、C-反应蛋白[(44.61±17.10)mg/L]显著高于肝功能正常组[(8.50±2.96)d,(1.94±0.84)×10^(9)/L,(35.18±10.01)U/L,(33.83±12.06)U/L,(43.85±30.45)U/L,(83.13±34.27)U/L,(4.05±1.41)mg/L,(3.17±0.69)g/L,(20.60±14.18)mg/L])及肝功能轻度损害组[(10.35±5.03)d,(2.50±1.22)×10^(9)/L,(72.65±14.01)U/L,(66.65±23.45)U/L,(74.63±67.64)U/L,(101.88±51.92)U/L,(4.75±1.86)mg/L,(3.18±0.72)g/L,41.38±35.32)mg/L],差异有统计学意义(χ^(2)=18.512,χ^(2)=16.633,χ^(2)=122.907,χ^(2)=95.379,χ^(2)=37.131,χ^(2)=22.120,χ^(2)=16.437,χ^(2)=12.590,χ^(2)=37.582,P<0.05)。肝功能中重度损害组患者的白细胞计数[(4.90±1.29)×10^(9)/L]、血小板计数[(115.29±31.45)×10^(9)/L]显著低于肝功能正常组[(5.99±2.08)×10^(9)/L,(157.63±51.09)×10^(9)/L]及肝功能轻度损害组[(5.618±1.84)×10^(9)/L,(128.45±35.74)×10^(9)/L],差异有统计学意义(χ^(2)=11.582,和χ^(2)=26.340,P<0.05)。多元Logisticlogistic回归分析结果显示,白细胞计数(OR=0.536,95%CI:0.348~0.826)、淋巴细胞计数(OR=3.457,95%CI:1.736~6.884)、血小板计数(OR=0.979,95%CI:0.960~0.998)、纤维蛋白原(OR=5.275,95%CI:1.686~16.507)、β2-微球蛋白(OR=2.011,95%CI:1.169~3.460)是恙虫病患者发生中重度肝功能损害的独立危险因素(P<0.05)。淋巴细胞计数的ROC曲线下面积(0.678)最大,其次为纤维蛋白原(0.674)、β2微球蛋白(0.672)、白细胞计数(0.337),血小板计数的ROC曲线下面积(0.281)最小。结论联合检测恙虫病患者的白细胞计数、淋巴细胞计数、血小板计数、纤维蛋白原、β2-微球蛋白水平,可以反应映恙虫病患者肝功能损害程度,对病情进展评估也具有重要临床应用价值。

Objective To investigate the inflammation markers and associated risk factors for moderate-to-severe hepatic dysfunction in patients with tsutsugamushi disease presenting with liver impairment.Methods A retrospective study was conducted on 143 hospitalized patients diagnosed with scrub typhus at Nanjing Drum Tower Hospital Group Suqian Hospital from January 2016 to December 2020.Based on alanine aminotransferase levels,patients were categorized into normal liver function,mild liver function impairment,and moderate-to-severe liver function impairment groups.Statistically significant items underwent Multivariate logistic regression analysis to determine independent risk factors for liver impairment.Results In patients with Tsutsugamushi disease,there were no statistically significant differences in gender,age,and duration of diabetes among those with normal liver function,mild liver fuction impairment,and moderate to severe liver function impairment(P>0.05).The biochemical markers,specifically total bilirubin levels(11.12±5.66,12.77±12.55,10.78±3.93μmol/L,χ^(2)=0.226),showed no statistical difference(P>0.05).Patients with moderate to severe liver function impairment had a significantly longer hospital stay(12.67±5.25 d),and elevated levels of lymphocyte count(3.19±1.51×10^(9)/L),alanine aminotransferase(190.45±97.66 U/L),aspartate aminotransferase(142.24±95.94 U/L),glutamyl transpeptidase(152.38±133.05 U/L),alkaline phosphatase(144.96±82.29 U/L),β2-microglobulin(7.17±9.13 mg/L),fibrinogen(3.60±0.54 g/L)and C-reactive protein(44.61±17.10 mg/L).These values were significantly higher compard to the normal liver function group and mild liver duction impairment group.The differences were statistically significant(β2 values provided,P<0.05).Multivariate logstic regression analysis indicated that white blood cell count(OR=0.536,95%CI:0.348~0.826),lymphocyte count(OR=3.457,95%CI:1.736~6.884),platelet count(OR=0.979,95%CI:0.960~0.998),fibrinogen(OR=5.275,95%CI:1.686~16.507),andβ2-microglobulin(OR=2.011,95%CI:1.169~3.460)were independent risk factors for the occurrence of moderate to severe liver fuction impairment in Tsutsugamushi disease patients(P<0.05).The area under the ROC curve was highest for lymphocyte count(0.678),followed by fibrinogen(0.674),andβ2-macroglobulin(0.672),It was lowest for white blood cell count(0.337),and platelet count(0.281).Conclusion The combined assessment of white blood cell count,lymphocyte count,platelet count,fibrinogen,andβ2-microglobulin levels in patients with Tsutsugamushi disease provides insights into the extent of liver function damage.This combined approach holds significant clinical value for evaluating the progression of the disease.