|
摘要：
|
|
摘要：目的 探讨血清白细胞介素12（interleukin 12，IL-12）、白细胞介素18
（interleukin 18，IL-18）、C反应蛋白（C-reactive protein，CRP）联合检测对肝硬化并
发自发性细菌性腹膜炎（spontaneous bacterial peritonitis，SBP）患者的预后评估价值。
方法 选择2021年8月至2022年8月在承德医学院附属医院确诊并接受治疗的120例肝硬化
并发SBP患者为研究对象，均给予相应的对症治疗，分别于入院当天和治疗14 d后采集
患者空腹肘静脉血5 ml，采用酶联免疫吸附试验（enzyme-linked immunosorbent assay，
ELISA）检测血清IL-12、IL-18水平，采用速率散射免疫比浊法检测血清CRP水平，分
析治疗前后患者血清IL-12、IL-18、CRP水平变化情况。治疗结束后随访90 d，根据预
后将患者分为存活组和死亡组，比较两组患者各项临床资料并采用Cox回归分析影响
肝硬化并发SBP患者90 d内死亡的危险因素，绘制受试者工作特征（receiver operating
characteristic，ROC）曲线评估血清IL-12、IL-18、CRP联合检测对肝硬化并发SBP患者
预后的预测价值。结果 120例患者均完成治疗，随访期间死亡21例，存活99例。治疗
后患者血清IL-12 [（36.67 ± 4.57）ng/L比（67.53 ± 8.16）ng/L]、IL-18 [（60.19 ± 7.04）ng/L
比（111.06 ± 12.58）ng/L]、CRP [（19.56 ± 2.24）mg/L比（42.65 ± 5.53）mg/L] 水平均
较治疗前显著降低（P均＜ 0.05）。死亡组患者肝性脑病 [33.33%（7/21）比14.14%
（14/99）]、肝肾综合征 [42.86%（9/21）比18.18%（18/99）] 比例以及白蛋白 [（22.34 ±
2.52）g/L比（25.53 ± 2.64）g/L]、总胆红素 [（47.56 ± 4.90）μmol/L比（33.34 ± 3.58）μmol/L]、
治疗后IL-12 [（40.01 ± 4.16）ng/L比（35.96 ± 4.02）ng/L]、治疗后IL-18 [（65.28 ±
7.02）ng/L比（59.11 ± 6.31）ng/L]、治疗后CRP [（23.19 ± 3.34）mg/L比（18.79 ±
2.36）mg/L] 水平均高于存活组（P均＜ 0.05）。Cox回归分析显示，肝性脑病（HR =
1.893，95%CI：1.379～2.406，P ＜ 0.001）、肝肾综合征（HR = 1.749，95%CI：
1.225～2.273，P ＜ 0.001）、低白蛋白（HR = 1.756，95% CI：1.108～2.404，P ＜
0.001）、治疗后IL-12（HR = 1.996，95%CI：1.226～2.765，P ＜ 0.001）、IL-18
（HR = 1.564，95%CI：1.117～2.010，P ＜ 0.001）、CRP（HR = 2.385，95%CI：
1.856～2.913，P ＜ 0.001）水平高均是导致肝硬化并发SBP患者90 d内死亡的危险因
素。治疗后血清IL-12、IL-18、CRP水平联合预测肝硬化并发SBP患者90 d内死亡的
ROC曲线下面积为0.906，约登指数为0.638，高于治疗后单独血清IL-12、IL-18、CRP
预测的ROC曲线下面积（0.791、0.805、0.802；z值分别为2.996、2.819、2.847，P值分
别为0.022、0.031、0.027）。结论 血清IL-12、IL-18、CRP水平升高与肝硬化并发SBP
患者90 d内死亡有关，可用于预测肝硬化并发SBP患者的死亡风险，三者联合的预测价值
更高。
|
|
Abstract: Objective To investigate the prognostic assessment value of combined serum
interleukin 12 (IL-12), interleukin 18 (IL-18), and C-reactive protein (CRP) detection in
liver cirrhosis patients complicated with spontaneous bacterial peritonitis (SBP). Methods
Total of 120 liver cirrhosis patients complicated with SBP in Affiliated Hospital of Chengde
Medical College from August 2021 to August 2022 were selected. The patients were given
corresponding symptomatic treatment and 5 ml fasting elbow venous blood was collected on
the day of admission and 14 d after treatment, serum IL-12 and IL-18 level was measured
by enzyme-linked immunosorbent assay (ELISA) and serum CRP levels were measured by
rate-scattering immunoturbidimetry, the changes of serum IL-12, IL-18 and CRP levels were
analyzed before and after treatment. At the end of treatment, patients were followed up for
90 d and divided into survival group and death group according to their prognosis, clinical
data was compared between the two groups and Cox regression analysis was used to analyze
the risk factors affecting death within 90 d in liver cirrhosis patients complicated with SBP.
The predictive value of serum IL-12, IL-18 and CRP on prognosis of liver cirrhosis patients
complicated with SBP was assessed by receiver operating characteristic (ROC) curve. Results
All of the 120 patients completed the treatment, 21 cases died and 99 cases survived during the
follow-up period. The serum IL-12 [(36.67 ± 4.57) ng/L vs. (67.53 ± 8.16) ng/L], IL-18 [(60.19 ±
7.04) ng/L vs. (111.06 ± 12.58) ng/L] and CRP [(19.56 ± 2.24) mg/L vs. (42.65 ± 5.53) mg/L]
levels of patients after treatment were significantly lower than those before treatment (all
P ＜ 0.05). The proportion of hepatic encephalopathy [33.33% (7/21) vs. 14.14% (14/99)],
proportion of hepatorenal syndrome [42.86% (9/21) vs. 18.18% (18/99)], albumin [(22.34 ±
2.52) g/L vs. (25.53 ± 2.64) g/L], total bilirubin [(47.56 ± 4.90) μmol/L vs. (33.34 ± 3.58) μmol/L],
IL-12 after treatment [(40.01 ± 4.16) ng/L vs. (35.96 ± 4.02) ng/L], IL-18 after treatment
[(65.28 ± 7.02) ng/L vs. (59.11 ± 6.31) ng/L] and CRP after treatment [(23.19 ± 3.34) mg/L vs.
(18.79 ± 2.36) mg/L] were significantly higher in death group than those in survival group (all
P ＜ 0.05). Cox regression analysis showed that hepatic encephalopathy (HR = 1.893, 95%CI:
1.379～2.406, P ＜ 0.001), hepatorenal syndrome (HR = 1.749, 95%CI: 1.225～2.273, P ＜
0.001), low albumin (HR = 1.756, 95%CI: 1.108～2.404, P ＜ 0.001) and high IL-12 (HR =
1.996, 95%CI: 1.226～2.765, P ＜ 0.001), IL-18 (HR = 1.564, 95%CI: 1.117～2.010, P ＜
0.001) and CRP (HR = 2.385, 95%CI: 1.856～2.913, P ＜ 0.001) levels after treatment were
risk factors for death within 90 d in liver cirrhosis patients complicated with SBP. The area
under ROC curve of serum IL-12, IL-18 and CRP combined detection on death within 90 d in
liver cirrhosis patients with SBP was 0.906 (Youden index was 0.638), which was significantly
higher than that of IL-12 (0.791), IL-18 (0.805) and CRP (0.802) alone (z = 2.996, 2.819,
2.847; P = 0.022, 0.031, 0.027). Conclusions Elevated serum IL-12, IL-18 and CRP levels are
associated with death within 90 d in liver cirrhosis patients complicated with SBP and can be
used to predict the risk of death in 90 d, and the predictive value of combination of IL-12, IL-18
and CRP was higher.
|
|
基金项目：
|
|
|
|
作者简介：
|
|
|
|
参考文献：
|
|
|
|
服务与反馈：
|
|
【文章下载】【加入收藏】
|
|
|
|