降钙素原、HMGB1联合NLR在尿毒症合并脓毒症患者中的临床应用价值

Clinical Application Value of Procalcitonin and HMGB1 Combined with NLR in Patients with Uremia and Pyemia

目的:探讨降钙素原(procalcitonin,PCT)、高迁移率族蛋白B1(high mobility group protein B1,HMGB1)、中性粒细胞与淋巴细胞的比值(eutrophil-to-lymphocyte ratio,NLR)联合检测在尿毒症合并脓毒症患者中的临床应用价值。方法:选择赣州市人民医院感染性疾病科于2021年1月—2023年12月收治的77例疑似尿毒症合并脓毒症的患者为研究对象。入院后均行PCT、HMGB1及NLR检查,比较患者入院第1、2、3、7天及停抗生素后1 d的PCT、HMGB1及NLR水平,以及入院第1天的病情程度,并以临床诊断为金标准,分析三种检测方式及三种联合诊断效能。结果:77例患者中最终临床诊断为尿毒症合并脓毒症患者70例,急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分为(17.64±3.25)分;患者入院第1、2、3、7天的PCT、HMGB1及NLR水平均逐渐降低,但停抗生素后1 d上升(P<0.05);联合检测敏感度、特异度及准确度均高于三项指标单独检测,误诊率、漏诊率均低于三项指标单独检测,差异均有统计学意义(P<0.05);相关性分析显示,PCT、HMGB1、NLR水平与APACHEⅡ评分均呈正相关(P<0.05)。结论:相较于PCT、HMGB1及NLR三项单独检测,联合检测在尿毒症合并脓毒症患者诊断中更为准确,可提高预警效能,较少误诊、漏诊,对判断患者病情严重程度具有重要的临床应用价值。

Objective:To investigate the clinical application value of combined detection of procalcitonin(PCT),high mobility group protein B1(HMGB1)and neutrophil-to-lymphocyte ratio(NLR)in patients with uremia and pyemia.Method:Seventy-seven patients who were suspected of uremia with pyemia and admitted to Ganzhou People's Hospital from January 2021 to December 2023 were selected as the study subjects.All of them were tested for PCT HMGB1 and NLR after admission.The levels of PCT,HMGB1 and NLR on the 1st,2nd,3rd and 7th day after admission and on 1 day after antibiotics withdrawal,and condition on the 1st day after admission were compared.With clinical diagnosis as the gold standard,diagnostic efficacy of PCT,HMGB1,NLR,and their combination was analyzed.Result:Of the 77 patients,70 cases were diagnosed with uremia combined with sepsis.The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score was(17.64±3.25)scores.The levels of PCT,HMGB1 and NLR decreased gradually on the 1st,2nd,3rd and 7th day after admission,but increased on 1 day after antibiotics withdrawal(P<0.05).The sensitivity,specificity and accuracy of combined detection were higher than those of separate detection,the misdiagnosis rate and missed diagnosis rate were lower than those of separate detection,the differences were statistically significant(P<0.05).Correlation analysis showed that PCT,HMGB1 and NLR levels were positively correlated with APACHEⅡscores(P<0.05).Conclusion:Compared to separate detection of PCT,HMGB1 and NLR,combined detection is more accurate in the diagnosis of patients with uremia and pyemia.It can improve warning efficacy,and reduce misdiagnosis and missed diagnosis,which is important for determining the patient's condition.