慢加急性乙型肝炎肝衰竭患者细菌感染病原菌分布及血清PCT、IFN-γ和IL-6水平变化分析*

doi:10.3969/j.issn.1672-5069.2024.01.017

摘要/Abstract

摘要： 目的调查慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者细菌感染病原菌分布特征,分析血清降钙素原(PCT)、干扰素-γ(IFN-γ)和白细胞介素-6(IL-6)水平预测细菌感染的效能。方法 2019年12月～2023年1月我院收治的HBV-ACLF患者86例,常规分离和鉴定菌种,采用电化学发光免疫法检测血清PCT水平,采用ELISA法检测血清IFN-γ和IL-6水平,应用受试者工作特征(ROC)曲线评估血清指标联合预测HBV-ACLF患者发生细菌感染的效能。结果本组发生细菌感染者37例,未发生明确感染者49例;在37例HBV-ACLF并发细菌感染患者中,共检出68株感染病原菌,其中革兰氏阴性菌41株(60.3%),革兰氏阳性菌27株(39.7%);感染组血清PCT、IFN-γ和IL-6水平分别为(10.9±3.1)μg/L、(46.5±1.9)pg/mL和(16.9±1.6)pg/mL,均显著高于未感染组【分别为(0.9±0.1)μg/L、(20.1±2.4)pg/mL和(4.8±0.9)pg/mL,P＜0.05】,28 d和90 d病死率分别为67.6%和75.7%,均显著高于未感染组(分别为8.2%和12.2%,P＜0.05);经ROC分析显示,分别以PCT＞3.3μg/L、IFN-γ＞45.5 pg/mL和IL-6＞15.4pg/mL为截断点,其联合预测HBV-ACLF患者并发细菌感染的曲线下面积(AUC)为0.874,诊断的灵敏度为93.6%,特异度为84.1%。结论 HBV-ACLF患者细菌感染的病原菌分布具有一定的特征性,以革兰氏阴性菌感染为主,除检测血清PCT水平外,监测血清IFN-γ和IL-6水平可能有助于早期发现细菌感染而给予预防性处理,或能提供生存率。

关键词: 慢加急性乙型肝炎肝衰竭, 细菌感染, 降钙素原、干扰素-γ, 白细胞介素-6, 诊断

Abstract: Objective The aim of this study was to investigate the pathogenic bacteria distribution and serum interferon-gamma (IFN-γ) and interleukin-6 (IL-6) level changes in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) complicated by bacterial infections. Methods 86 patients with HBV-ACLF were admitted to our hospital between December 2019 and January 2023, and the bacteria were isolated and identified routinely. Serum procalcitonin (PCT) level was detected by electrochemiluminescence immunoassay, and serum IFN-γ and IL-6 levels were assayed by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic (ROC) curve. Results 37 patients in our series were found having bacterial infection, and out of them, 68 pathogenic bacteria strains were characterized with Gram-negative bacteria infection in 41 strains and Gram-positive bacterial infection in 27 strains(39.7%); serum PCT, IFN-γ and IL-6 levels in patients with bacterial infection were (10.9±3.1)μg/L, (46.5±1.9)pg/mL and (16.9±1.6)pg/mL, all significantly higher [(0.9±0.1)μg/L, (20.1±2.4)pg/mL and (4.8±0.9)pg/mL, respectively, P＜0.05], and 28-day and 90-day fatality rates were 67.6% and 75.7%, both significantly higher than 8.2% and 12.2% (P＜0.05) in patients without bacterial infection; the ROC analysis showed that the AUC was 0.874, with the sensitivity of 93.6% and the specificity of 84.1%, when the combination of serum parameters was applied to predict bacterial infection as serum PCT＞3.3μg/L, serum IFN-γ＞45.5 pg/mL and IL-6＞15.4 pg/mL was set as the cut-off-value. Conclusion The distribution of pathogenic bacteria in patients with HBV-ACLF complicated by bacterial infections is characteristic, and the Gram-negative bacteria is the main common pathogenic bacteria. Besides serum PCT level, the surveillance of serum IFN-γ and IL-6 levels is helpful for early diagnosis of bacterial infection in this setting.

Key words: Acute-on-chronic liver failure, Bacterial infection, Procalcitonin, Interferon-gamma, Interleukin-6, Diagnosis

杨晶, 陈美玲, 张丽秀, 颜鲁伟, 白正强, 贺锐. 慢加急性乙型肝炎肝衰竭患者细菌感染病原菌分布及血清PCT、IFN-γ和IL-6水平变化分析^*[J]. 实用肝脏病杂志, 2024, 27(1): 64-67.

Yang Jing, Chen Meiling, Zhang Lixiu, et al. Pathogenic bacteria distribution and serum IFN-γ and IL-6 level changes in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by bacterial infections[J]. Journal of Practical Hepatology, 2024, 27(1): 64-67.

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慢加急性乙型肝炎肝衰竭患者细菌感染病原菌分布及血清PCT、IFN-γ和IL-6水平变化分析^*

Pathogenic bacteria distribution and serum IFN-γ and IL-6 level changes in patients with hepatitis B virus-related acute-on-chronic liver failure complicated by bacterial infections

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