Objective To investigate the value of serum procalcitonin (PCT) in early diagnosis of bacterial infection in patients with liver failure.Methods A total of 463 patients with hepatitis B were selected from January to December,2014,in the Department of Infectious Diseases,Taihe Hospital.According to the degree of liver injury,the patients were divided into four groups:mild liver injury group (n =120),moderate liver injury group (n =222),sever liver injury group (n =53),and liver failure group (n =68).Serum PCT was measured for all patients,and the white blood cell count (WBC) and high-sensitivity C-reactive protein (hsCRP) were measured for patients with liver failure.The clinical manifestations were observed and recorded.The t test was used for comparison of normally distributed continuous data,while the Kruskal-Wallis H test was used for non-normally distributed continuous data;the Mann-Whitney U test was used for pairwise comparison of continuous data.The chi-square test was used for comparison of categorical data.The receiver operating characteristic (ROC) curve was used for the analysis of predictive value.Results The liver failure group had a significantly higher PCT level than the severe liver injury group,moderate liver injury group,and mild liver injury group (0.81 [0.34-2.15] vs 0.53 [0.21-1.59],0.35 [0.10-1.18],and 0.17 [0.10-0.60],x2 =25.091,P ＜ 0.05).The liver failure patients with PCT levels of ＜ 0.25 ng/ml (n =10),0.25-0.5 ng/rrd (n =10),and ＞ 0.5 ng/ml (n =48) had infection rates of 20％,30％,and 66.7％,respectively,with a significant difference between the patients with a PCT level of ＞ 0.5 ng/ml and those with PCT levels of ＜ 0.25 ng/ml and 0.25-0.5 ng/ml (x2 =5.631,4.650,P =0.018,0.031).Among the liver failure patients,the infection cases had significantly higher PCT,WBC,and hsCRP than the non-infection cases (PCT:3.72 ± 1.33 ng/ml vs 0.34 ±0.12 ng/ml,t =-2.547,P =0.015;hsCRP:16.70 ±7.03 mg/L vs 11.00 ± 6.52 mg/L,t =-3.458,P =0.001);the hsCRP level in both infection and non-infection cases was higher than the normal value,and the WBC in both infection and non-infection cases was lower than the normal value.In the 37 liver failure patients with infection,13 (35.14％) had no symptoms and signs associated with infection,but had significantly increased serum PCT.As for the predictive value of PCT for bacterial infection,the area under the ROC curve was 0.691,with a sensitivity of 0.737 and a specificity of 0.700.Conclusion The patients with liver failure are susceptible to bacterial infection.Serum PCT measurement has great significance for early diagnosis of bacterial infection in patients with liver failure.%目的 探讨血清降钙素原(PCT)检测对于肝衰竭合并感染早期诊断的价值.方法 选取2014年1月-2014年12月十堰市太和医院463例乙型肝炎患者,按肝功能指标分为轻度肝损伤组(n =120)、中度肝损伤组(n =222)、重度肝损伤组(n=53)和肝衰竭组(n=68),对各组PCT水平进行检测,对肝衰竭患者进一步测定WBC、高敏C反应蛋白(hsCRP)并观察临床表现.计量资料符合正态分布组间比较采用t检验,不符合正态分布的多组间比较采用Kruskal-WallisH检验,组间两两比较采用Mann-Whit-ney u检验;计数资料组间比较采用,检验;预测分析采用受试者工作特征曲线(ROC曲线)法.结果 肝衰竭组PCT水平[0.81(0.34～2.15)]明显高于重度肝损伤组[0.53(0.21 ～1.59)]、中度肝损伤组[0.35(0.10～1.18)]及轻度肝损伤组[0.17(0.10～0.60)],组间比较差异有统计学意义(x2=25.091,P＜0.05).肝衰竭患者中PCT ＜0.25 ng/ml(n=10)、0.25～0.5 ng/ml(n=10)、＞0.5 ng/ml(n =48)的发生感染的几率分别为20％、30％、66.7％,PCT＞0.5 ng/ml组与＜0.25 ng/ml组及0.25～0.5 ng/ml组比较差异均有统计学意义(x2值分别为5.631、4.650,P值分别为0.018、0.031);感染组PCT(3.72±1.33) ng/ml、hsCRP(16.70±7.03) mg/L水平较非感染组水平[PCT(0.34±0.12) ng/ml、hsCRP(11.00±6.52) mg/L]升高(t值分别为-2.547、-3.458,P值分别为0.015、0.001),hsCRP水平在感染组及非感染组均高于正常参考值,WBC水平在感染组及非感染组均低于正常参考值;37例确诊肝衰竭并感染者中13例(35.14％)无感染相关症状及体征,但PCT明显升高.应用ROC曲线分析PCT预测感染的曲线下面积为0.691,敏感度为0.737,特异度为0.700.结论 肝衰竭患者易并发感染,PCT检测对于早期诊断肝衰竭合并感染有重要意义.
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