摘要
目的：探讨常用炎性反应指标 IL‐6、降钙素原（PCT）、C 反应蛋白（CRP）在肝硬化合并感染性发热患者的早期诊断价值及成本效益分析。方法选择2012年1月至2015年1月福建医科大学附属第一医院肝病中心确诊为肝硬化的住院患者，排除社区获得性感染后，选择入院48 h 后出现发热的患者，根据最后是否诊断为感染，分为感染性发热组和非感染性发热组。收集其入院时（基线）和发热即刻的白细胞计数（WBC）、中性粒细胞比例、IL‐6、PCT 、CRP ，通过受试者工作特征（ROC）曲线分析各指标在肝硬化并感染性发热患者的早期诊断的阈值，并对上述指标进行成本效益比值（C／E）。结果共入选患者299例，男244例，女55例，平均年龄（55．1＆#177;13．0）岁。感染性发热组162例，非感染性发热患者137例。发热即刻，感染性发热组 WBC 、中性粒细胞比例、IL‐6、PCT 、CRP 较非感染性发热组高，差异均有统计学意义（均 P＜0．05）。 IL‐6诊断肝硬化并感染性发热的 ROC 曲线下面积（AUC）为0．939（95％ CI ：0．910～0．968），高于 PCT 的0．786和 CRP 的0．657，差异均有统计学意义（Z 值分别为5．718和9．048，均 P＜0．01）。IL‐6最佳诊断截点为184．5 ng／L ，灵敏度为85．2％，特异度为94．9％。中性粒细胞 C／E 值为38．3， CRP 为51．2，但两者灵敏度和特异度均较低；PCT 的 C／E 值为389．0，IL‐6为63．4，但 IL‐6具有最高的灵敏度（85．2％）及特异度（94．9％）。结论在肝硬化患者合并感染性发热早期，与 PCT 、CRP 相比，IL‐6诊断的敏感度、特异度最高，同时 C／E 相对较低，值得临床推广应用。
Objective To investigate the early diagnostic value and cost‐effectiveness analysis of common inflammatory markers , including interleukin‐6 （IL‐6 ） , procalcitonin （PCT ） and C‐reactive protein （CRP） in cirrhotic patients with infectious fever .Methods From January 2012 to January 2015 , cirrhotic patients hospitalized in liver center of First Affiliated Hospital ,Fujian Medical University who were excluded with community‐acquired infections and developed fever 48 hours after admission were selected .According to having infection or not ,they were divided into infection group and non‐infection group .White blood cell count （WBC） ,neutrophil percentage （N % ） ,IL‐6 ,PCT ,and CRP at admission （baseline） and at the time point of fever were recorded .The diagnostic threshold of WBC ,N% ,IL‐6 , PCT ,and CRP for infectious fever in cirrhotic patients were analyzed by receiver operating characteristic analysis curve （ROC） .The cost‐effectiveness （C/E） of those biomarkers were compared .Results A total of 299 cases were enrolled ,with 162 in infection group and 137 in non‐infection group .Two hundred and forty‐four were male and 55 were female .The mean age was 55 .1 ＆#177; 13 .0 years .Upon the onset of fever , WBC ,N% ,IL‐6 ,PCT ,and CRP of infection group were all significantly higher than those of non‐infection group （all P〈 0 .05） .The area under the curve of IL‐6 for infectious fever was 0 .939 （95% CI 0 .910 - 0 .968） ,which was significantly higher than those of PCT and CRP （Z = 5 .718 and 9 .048 ,＆amp;nbsp;respectively ,both P〈 0 .01） .The optimal cut‐off point of IL‐6 was 184 .5 ng/L ,with the sensitivity of 85 .2% and specificity of 94 .9% .C/E value was 38 .3 for N% ,and 51 .2 for CRP . However ,both specificity and specificity of CRP and N % were low .C/E value was 389 .0 for PCT and 63 .4 for IL‐6 .IL‐6 had the highest sensitivity （85 .2% ） and specificity （94 .9% ） among all the biomarkers .Conclusions Compared to PCT and CRP ,IL‐6 has the highest sensitivity and specificity with lower cost‐effectiveness for diagnosis of infectious fever in cirrhotic patients .
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2016年第6期327-331,共5页
Chinese Journal of Infectious Diseases
基金
天晴肝病研究基金项目（TGBB20140087）
福建省科技厅引导性项目（2016Y0040）
关键词
肝硬化
感染
白细胞介素-6
降钙素原
C
反应蛋白
成本效益分析
Liver cirrhosis
Infection
Interleukin-6
Procalcitonin
C-reactive protein
Cost-effectiveness analysis
