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.

参考文献

[1] Zhao F, Xie X, Tan X, et al. The functions of hepatitis B virus encoding proteins: viral persistence and liver pathogenesis. Front Immunol, 2021, 12(1):691766.
[2] Luo J, Liang X, Xin J, et al. Predicting the onset of hepatitis B virus-related acute-on-chronic liver failure. Clin Gastroenterol Hepatol, 2023, 21(3):681-693.
[3] Tang X, Qi T, Li B, et al. Tri-typing of hepatitis B-related acute-on-chronic liver failure defined by the World Gastroenterology Organization. J Gastroenterol Hepatol, 2021, 36(1):208-216.
[4] 黄涛,田琼林,张雪雪,等.慢加急性肝衰竭继发细菌感染病原菌及预后评估.中华医院感染学杂志,2022,32(6):861-865.
[5] Wong F, Piano S, Singh V, et al. Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure. J Hepatol, 2021, 74(2):330-339.
[6] Su H, Tong J, Liu X, et al. Characteristics and outcome of nosocomial bloodstream infection in patients with acute-on-chronic liver failure. Eur J Gastroenterol Hepatol, 2021, 33(1):83-88.
[7] Gu Y, Chen L, Lian Y, et al. Serum HBV pregenomic RNA is correlated with Th1 / Th2 immunity in treatment-naïve chronic hepatitis B patients. J Med Virol, 2020, 92(3):317-328.
[8] Wu ZB, Zheng YB, Wang K, et al. Plasma interleukin-6 level: A potential prognostic indicator of emergent HBV-associated ACLF. Can J Gastroenterol Hepatol, 2021, 11(2):5545181.
[9] 中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版).实用肝脏病杂志,2018,11(6):210-216.
[10] 中华人民共和国卫生部.医院感染诊断标准.中华医学杂志,2001,81(5):315-320.
[11] Yao N, He Y, Wu Y, et al. Prognostic value of plasma level of superoxide dismutase in HBV-related acute-on-chronic liver failure. BMC Gastroenterol, 2022, 22(1):312.
[12] Xu W, Li Y, Wang L, et al. Efficacy and safety of combination treatment of double plasma molecular adsorption system and low volume plasma exchange for patients with hepatitis B virus related acute-on-chronic liver failure: a multicentre randomised controlled clinical trial. BMJ Open, 2021, 11(12):e047690.
[13] 刘英辉,周东方,金国华,等.血清胃泌素与胃动素及炎症因子联合SIRS评分评估HBV-ACLF并发细菌感染的临床价值.中华医院感染学杂志,2021,31(11):1601-1606.
[14] Hossain SMS, Mahtab MA, Das DC, et al. Comparative role of tenofovir versus entecavir for treating patients with hepatitis B virus related acute on chronic liver failure. J Family Med Prim Care,2021,10(7):2642-2645.
[15] Weng WZ, Chen JF, Peng XH, et al. Risk factors for underlying comorbidities and complications in patients with hepatitis B virus-related acute-on-chronic liver failure. Epidemiol Infect, 2022, 50(1):e147.
[16] Li C, Su HB, Liu XY, et al. Clinical characteristics and 28-d outcomes of bacterial infections in patients with hepatitis B virus-related acute-on-chronic liver failure. World J Clin Cases, 2020, 8(6):1042-1055.
[17] 程晓燕,赵爱明,李海丹,等.慢加急性乙型肝炎肝衰竭患者医院感染病原菌分布及血清Th1/Th2型细胞因子水平变化.实用肝脏病杂志,2023,26(2):246-249.
[18] Wang K, Zhang Z, Mo ZS, et al. Gut microbiota as prognosis markers for patients with HBV-related acute-on-chronic liver failure. Gut Microbes, 2021, 13(1):1-15.
[19] Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology, 2021, 74(2):1014-1048.
[20] Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, et al. Procalcitonin to reduce long-term infection-associated adverse events in sepsis. A randomized trial. Am J Respir Crit Care Med, 2021, 203(2):202-210.
[21] Zhang DN, Liu Y, Li X, et al. Imbalance between soluble and membrane-bound CD100 regulates monocytes activity in hepatitis B virus-associated acute-on-chronic liver failure. Viral Immunol, 2021, 34(4):273-283.
[22] Zhou C, Zhang N, He TT, et al. High levels of serum interleukin-6 increase mortality of hepatitis B virus-associated acute-on-chronic liver failure. World J Gastroenterol, 2020, 26(30):4479-4488.

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

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	虞珊珊, 张业婷, 王元鹏, 袁静文, 肖立. 慢性乙型肝炎患者血清MMP-1、MMP-2、TIMP-1和HIF-1α变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(3): 329-332.
[2]	彭玉静, 郭航, 陈俊光. 应用超声评分联合STE/STQ定量检测肝脏硬度评估慢性乙型肝炎患者肝纤维化程度价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 345-348.
[3]	曹焱芬, 邹昊轩, 谢艳. 体检人群血浆致动脉粥样硬化指数诊断代谢相关脂肪性肝病效能分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 361-365.
[4]	高萍, 高学松, 张亦瑾, 孙磊, 刘楠, 李洪杰, 刘亚平, 高丽丽, 段雪飞. 8例血色病患者临床与基因突变特征分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 386-389.
[5]	董旭, 秦阳华, 陈怡, 许明晓, 葛玲玲, 徐圣, 廖威. 预后营养指数联合全身免疫炎症指数评估乙型肝炎相关慢加急性肝衰竭患者预后临床价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 390-393.
[6]	白萍, 王汉, 刘芮, 曾智萍. 多层螺旋CT与磁共振LAVA增强扫描诊断肝内占位性病变性质效能分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 422-425.
[7]	梅文娟, 李新, 张昊月. 超声造影时间-强度曲线相关参数鉴别诊断肝细胞癌与转移性肝癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 430-433.
[8]	王倩文, 胡琳琳, 徐运军. 动态增强MRI联合血清SPINK1水平诊断原发性肝癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 442-445.
[9]	师玉, 孟令辉, 王禄马. 肝内胆管细胞癌增强CT扫描特征及其诊断价值分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 446-449.
[10]	陈爱娥, 彭向前, 陈利娜. 术前多层螺旋CT检查胆囊结石合并胆囊炎患者对术式选择的指导意义分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 466-469.
[11]	徐京杭, 于岩岩, 徐小元. 肝硬化临床研究进展[J]. 实用肝脏病杂志, 2024, 27(2): 161-164.
[12]	郭萌, 郭琦, 张峰. 超声瞬时弹性成像检测受控衰减参数评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 189-192.
[13]	李敏, 张丽, 曾艾, 刘世裕. 2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化检出率及预测因素分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 193-197.
[14]	郑波, 哈丽达·夏尔甫哈孜, 谈理. 非酒精性脂肪性肝病患者血清HIF-1α、HMGB1和脂联素水平变化及其与颈动脉粥样硬化的关系研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 198-201.
[15]	童静, 张珂瓈, 李昌平. 非酒精性脂肪性肝炎患者血清前神经降压素和微小RNA-122水平变化及其诊断脂肪性肝炎的价值探讨^*[J]. 实用肝脏病杂志, 2024, 27(2): 202-205.