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投稿时间：2018-08-12 网络发布日期：2019-03-20
投稿时间：2018-08-12 网络发布日期：2019-03-20
中文摘要: 目的 探讨全身炎症反应综合征(SIRS)评分联合降钙素原(PCT)对乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者并发感染的预测价值。方法 回顾性分析2015年1月至2018年6月西南医科大学附属医院感染科收治入院的219例HBV-ACLF患者的临床资料,根据是否发生感染分为感染组(n=150)和非感染组(n=69)。在入院24 h内测定患者生命体征及相关实验室指标,并进行SIRS评分。Logistic回归分析HBV-ACLF患者并发感染的危险因素。绘制受试者工作特征曲线(ROC)分析SIRS评分联合PCT对HBV-ACLF患者并发感染的预测价值。结果 感染组年龄、SIRS评分、SIRS发生率、白细胞计数(WBC)、中性粒细胞率(NEU%)、凝血酶原时间-国际标准化比值(PT-INR)、PCT、总胆红素、直接胆红素、腹水发生率均大于非感染组,血红蛋白(HGB)、凝血酶原活动度(PTA)、丙氨酸氨基转移酶、白蛋白、乳酸脱氢酶均小于非感染组(P<0.05)。年龄大和高SIRS评分、高WBC、高NEU、高PCT以及腹水为HBV-ACLF患者发生感染的危险因素(OR)分别为1.110、4.015、1.125、3.431、1.054、5.009(P<0.05或P<0.01)。 SIRS评分与PCT的ROC曲线下面积（AUC）分别为0.618和0.683。SIRS评分联合PCT的AUC为0.749。结论 在HBV-ACLF患者中,高SIRS评分和高PCT是其并发感染的危险因素。SIRS评分联合PCT对HBV-ACLF患者并发感染的预测价值更高。
Abstract:Objective To investigate the value of systemic inflammatory response syndrome (SIRS) score combined with procalcitonin (PCT) in predicting infection in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data of 219 patients with HBV-ACLF admitted to the Infectious Diseases Department from January 2015 to June 2018 were retrospectively analyzed. The patients were divided into infection group (n=150) and non-infection group (n=69) according to whether they had infection. Within 24 hours of admission, the vital signs and relevant laboratory indicators of patients were measured, and SIRS scoring was performed. Logistic regression analysis was used to analyze the risk factors associated with infection for HBV-ACLF patients. The area under the ROC curve (AUC) of SIRS score combined with PCT was analyzed to evaluate the predictive value of the combination of SIRS score and PCT on concurrent infection in HBV-ACLF patients. Results Age, SIRS score, SIRS incidence, white blood cell count (WBC),neutrophil rate (NEU%),prothrombin time- international normalized ratio (PT-INR), PCT, total bilirubin (TBIL),direct bilirubin (DBIL)and incidence of ascites in infection group were significantly higher than those in non-infected group(P<0.05).Hemoglobin (HGB), prothrombin time activity (PTA),alanine aminotransferase (ALT),albumin (ALB)and lactate dehydrogenase (LDH)in infection group were significantly lower than those in non-infected group(P<0.05).Age, high SIRS score, high WBC, high NEU%, high PCT and ascites were the risk factors or infection occurrence in HBV-ACLF patients (OR) were 1.110,4.015,1.125,3.431,1.054,5.009,respectively(P<0.05,P<0.01).The AUC of the SIRS score and the PCT were 0.618 and 0.683,respectively. The AUC of SIRS score was 0.618 and the AUC of PCT was 0.683. The AUC of SIRS score combined with PCT was 0.749. Conclusion In HBV-ACLF patients, high SIRS score and high PCT are the risk factors of infection occurrence, while SIRS score combined with PCT has a higher predictive value for infection occurrence in patients with HBV-ACLF.
keywords: Liver failure Systemic inflammatory response syndrome Procalcitonin Hepatitis B virus Infection
文章编号： 中图分类号： 文献标志码：A
基金项目:四川省卫计委科研项目（150076）
| Author Name | Affiliation |
| GUO Xiao-min*,JIANG Yu-feng | *Clinical Medical College of Southwest Medical University,Luzhou,Sichuan 646000,China |
引用文本：
郭小敏,蒋玉凤.SIRS评分联合PCT对HBV相关慢加急性肝衰竭并发感染的预测价值[J].中国临床研究,2019,32(3):289-293.
郭小敏,蒋玉凤.SIRS评分联合PCT对HBV相关慢加急性肝衰竭并发感染的预测价值[J].中国临床研究,2019,32(3):289-293.