血清HNL、PCT、sCD163及IL-6联合检测在老年患者脓毒症诊断中的应用价值

Application Value of Serum HNL,PCT,sCD163 and IL-6 Combined Detection in Diagnosis of Sepsis in Elderly Patients

目的探讨中性粒细胞载脂蛋白(HNL)联合其他感染相关生物标志物对老年脓毒症患者的诊断价值。方法选取2019年5月至2022年11月我院收治的115例老年患者为研究对象,根据“脓毒症-3”共识标准、临床病史和实验室检查将其分为脓毒症组(n=35)、急性局部细菌感染组(n=50)、病毒感染组(n=30)和健康对照组(n=50)。收集患者的静脉血样,分析全血细胞计数、血培养、微生物培养结果,HNL、降钙素原(PCT)、白介素-6(IL-6)和可溶性血红蛋白清道夫受体(sCD163)检测水平。结果在老年脓毒症患者诊断中,HNL和PCT联合检测的灵敏度为91.4%,特异度为98%,显著优于使用1.025 ng/ml作为PCT的最佳截止值所达到的灵敏度80%以及使用98.91 ng/ml作为HNL的最佳截止值所达到的特异度84%;在老年患者局部细菌感染诊断中,HNL和PCT联合检测的灵敏度为88%,特异度为90%,显著优于PCT和HNL单独检测的诊断效能。结论HNL和PCT联合检测有助于老年脓毒症以及局部细菌感染的早期诊断。

Objective To comprehensively evaluate the application of human neutrophil lipocalin(HNL)combined with other biomarkers in the early diagnosis of sepsis in elderly patients.Methods From May 2019 to November 2022,115 elderly patients treated in our hospital were selected.According to the“sepsis 3”consensus criteria,clinical history and laboratory examination,they were divided into:sepsis group(n=35),acute local bacterial infection group(n=50),viral infection group(n=30)and healthy control group(n=50).Intravenous blood samples were collected from patients after diagnosis and analyzed for CBC,blood culture,microbial culture,HNL,procalcitonin(PCT),interleukin-6(IL-6),and soluble hemoglobin scavenger receptor(sCD163)levels.Results In the diagnosis of sepsis in elderly patients,the sensitivity and specificity of combined detection of HNL and PCT were 91.4%and 98%,respectively,which were significantly better than those of using 1.025 ng/ml as the best cut-off value of PCT and 98.91 ng/ml as the best cut-off value of HNL(84%).In the diagnosis of local bacterial infection in elderly patients,the sensitivity and specificity of combined detection of HNL and PCT were 88%and 90%,which were significantly better than those of PCT and HNL alone.Conclusion HNL combined with PCT is helpful for early diagnosis of sepsis and local bacterial infection in elderly patients.