血清PCT、IL-26和IFN-γ水平联合MELD评分预测慢加急性乙型肝炎肝衰竭患者感染价值探讨*

doi:10.3969/j.issn.1672-5069.2026.02.018

摘要/Abstract

摘要： 目的探讨血清降钙素原(PCT)、白细胞介素-26(IL-26)和干扰素-γ(IFN-γ)联合终末期肝病模型(MELD)评分预测慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者感染的价值。方法 2021年1月～2024年12月我院收治的HBV-ACLF患者71例,采用荧光免疫层析法检测血清PCT水平,采用ELISA法检测血清IL-26和IFN-γ水平,常规获得临床指标,计算MELD评分。采用Logistic回归分析影响感染的危险因素,应用受试者工作特征(ROC)曲线并计算曲线下面积(AUC)评估诊断效能。结果本组71例HBV-ACLF患者发生感染34例(47.9%);感染患者血清PCT、IL-26水平和MELD评分分别为(2.7±1.0)ng/mL、(223.8±74.3)pg/mL和(29.5±4.2)分,均显著高于未感染患者【分别为(0.3±0.1)ng/mL、(135.7±32.4)pg/mL和(22.3±3.6)分,P＜0.05】,而血清IFN-γ水平为(20.2±5.5)ng/mL,显著低于未感染患者【(55.7±8.4)ng/mL,P＜0.05】;多因素Logistic回归分析显示,血清PCT(OR=2.214,95%CI:1.264～3.879)、IL-26(OR=2.040,95%CI:1.162～3.581)、IFN-γ(OR=3.854,95%CI:1.063～13.967)和MELD评分(OR=2.492,95%CI:1.474～4.213)均为影响HBV-ACLF患者发生感染的独立影响因素(P＜0.05);联合血清IFN-γ、PCT和IL-26水平和MELD评分预测HBV-ACLF患者发生感染的效能显著优于单个指标预测,其AUC=0.978,敏感度为94.1%,特异度为96.5%。结论血清PCT、IL-26和IFN-γ联合MELD评分预测HBV-ACLF患者感染具有一定价值。

关键词: 慢加急性肝衰竭, 感染, 降钙素原, 白细胞介素-26, 干扰素-γ, 终末期肝病模型, 诊断

Abstract: Objective The aim of this study was to explore diagnostic performance of serum procalcitonin (PCT), interleukin-26 (IL-26) and interferon-γ (IFN-γ) levels and model for end-stage liver disease (MELD) score in predicting secondary infection in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods 71 consecutive patients with HBV-ACLF were enrolled in our hospital between January 2021 and December 2024, serum PCT level was detected by fluorescence immunochromatography, serum IL-26 and IFN-γ levels were detected by ELISA, and MELD scores were calculated. Multivariate Logistic regression analysis was applied to find risk factors, and receiver operating characteristic curve and the area under the curve (AUC) was obtained to evaluate diagnostic efficacy. Results Of the 71 patients with HBV-ACLF, secondary bacterial infection was found in 34 cases (47.9%); serum PCT, IL-26 levels and MELD score in patients with infection were (2.7±1.0)ng/mL, (223.8±74.3)pg/mL and (29.5±4.2), all significantly higher than [(0.3±0.1)ng/mL, (135.7±32.4)pg/mL and (22.3±3.6), respectively, ,P＜0.05], while serum IFN-γ level was (20.2±5.5)ng/mL, significantly lower than [(55.7±8.4)ng/mL, P＜0.05] in those without infection; multivariate Logistic regression analysis showed that serum PCT(OR=2.214, 95%CI:1.264-3.879), IL-26(OR=2.040,95%CI:1.162-3.581), IFN-γ(OR=3.854, 95%CI:1.063-13.967) and MELD score (OR=2.492, 95%CI:1.474-4.213) were all independent risk factors for secondary infection in patients with HBV-ACLF(P＜0.05); the AUC was 0.978, with sensitivity of 94.1% and specificity of 96.5%, when serum IFN-γ, PCT and IL-26, and MELD was combined for prediction of infection in patients with HBV-ACLF, much superior to any parameter did alone. Conclusion Combination of serum PCT, IL-26, IFN-γ levels and MELD score has a certain predictive efficacy for secondary infection in patients with HBV-ACLF.

Key words: Acute-on-chronic liver failure, Infection, Procalcitonin, Interleukin-26, Interferon-γ, Model for end-stage liver disease, Diagnosis

储茜, 景龙宵, 张力, 孙恒亮. 血清PCT、IL-26和IFN-γ水平联合MELD评分预测慢加急性乙型肝炎肝衰竭患者感染价值探讨^*[J]. 实用肝脏病杂志, 2026, 29(2): 233-236.

Chu Qian, Jing Longxiao, Zhang Li, et al. Diagnostic performance of serum PCT, IL-26 and IFN-γ levels and MELD score in predicting secondary infection in patients with HBV-ACLF[J]. Journal of Practical Hepatology, 2026, 29(2): 233-236.

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血清PCT、IL-26和IFN-γ水平联合MELD评分预测慢加急性乙型肝炎肝衰竭患者感染价值探讨^*

Diagnostic performance of serum PCT, IL-26 and IFN-γ levels and MELD score in predicting secondary infection in patients with HBV-ACLF

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