【摘要】 目的:探讨血清中白细胞介素33(IL-33)与降钙素原(PCT)在慢加急性肝衰竭(ACLF)合并细菌感染中的表达水平及其临床意义。方法:纳入南阳市中心医院感染科140例ACLF患者作为研究对象，根据是否发生细菌感染，分为感染组(n=51)和非感染组(n=89)。所有患者在治疗30 d后根据病情是否发生恶化分为预后良好组(n=77)和预后不良组(n=63)。收集所有ACLF患者临床数据，血清中IL-33表达水平采用ELISA法检测。ACLF患者合并细菌感染的危险因素采用Logistic回归分析，血清中PCT和IL-33水平在诊断ACLF合并细菌感染的临床效能采用ROC曲线分析。结果:性别、年龄、Child-Pugh肝功能分级、ALT、AST、TBil、血氨、肌酐、PT、APTT、INR在非感染组和感染组患者中差异无统计学意义(P>0.05);与非感染组患者相比，WBC、中性粒细胞、hs-CRP、PCT、IL-33水平和MELD评分在感染组显著升高，而白蛋白水平显著降低，差异均有统计学意义(均P<0.05)。Logistic回归分析显示，MELD评分升高(OR=3.561)、PCT水平升高(OR=3.778)及IL-33水平升高(OR=4.665)是ACLF患者发生细菌感染的独立危险因素。与非感染组相比，感染组患者发生预后不良比例显著升高，差异有统计学意义(c2=36.227,P<0.001)。感染组出现预后不良患者血清PCT[(5.56±0.64)ng/ml]和IL-33[(111.03±11.48)mg/ml]水平均显著高于预后良好患者血清PCT[(4.44±0.52)ng/ml]和IL-33[(57.12±8.99)mg/ml]水平，差异均有统计学意义(均P<0.05);非感染组出现预后不良患者血清中PCT[(5.02±0.54)ng/ml]和IL-33[(103.34±10.46)mg/ml]水平均显著高于预后良好患者血清中PCT[(3.89±0.43)ng/ml]和IL-33[(45.34±7.98)mg/ml]水平，差异具有统计学意义(均P<0.05)。预后不良组中血清PCT[(5.12±0.61)ng/ml]和IL-33[(108.57±10.35)mg/ml]水平显著高于预后良好组血清中PCT[(4.18±0.48)ng/ml]和IL-33[(50.33±8.56)mg/ml]水平，差异具有统计学意义(均P<0.05)。ROC曲线结果显示，IL-33、PCT及IL-33联合PCT在诊断ACLF患者合并细菌感染的AUC分别为0.895、0.834和0.958,诊断敏感度和特异度均在85%以上，其中IL-33联合PCT在诊断ACLF患者合并细菌感染中的AUC显著高于IL-33和PCT(P<0.05)。结论:IL-33和PCT作为诊断ACLF患者发生细菌感染和评估发生预后不良具有良好的临床应用价值，且两者联合效果更佳。更多还原

【Abstract】 Objective:To investigate the expression levels of serum interleukin33(IL-33) and procalcitonin(PCT) in chronic acute liver failure(ACLF) complicated with bacterial infection and its clinical significance.Methods:A total of 140 patients with ACLF in the Department of Infection, Nanyang Central Hospital, were included and divided into the Infection group(n=51) and non-Infection group(n=89) according to the incidence of bacterial infection. After 30 days of treatment, the patients were defined as the poor prognosis group(n=63) when the disease worsened, and the remaining were defined as the good prognosis group(n=77). The clinical data of all ACLF patients were collected, and the serum IL-33 expression level was detected by ELISA methods. The risk factors of ACLF patients complicated with bacterial infection were analyzed by Logistic regression, and the clinical value of serum PCT and IL-33 levels in the diagnosis of ACLF complicated with bacterial infection was analyzed by ROC curve.Results:There were no significant differences in gender, age, Child-Pugh liver function grade, ALT, AST, TBIL, blood ammonia, creatinine, PT, APTT, and INR levels between non-Infection and Infection group(P>0.05). Compared with the non-Infection group, the levels of WBC, neutrophils, hs-CRP, PCT, IL-33 and MELD scores were significantly increased in the Infection group, while the levels of albumin were significantly decreased, with statistical significance(P<0.05). The Logistic regression analysis showed that increased MELD score(OR=3.561), PCT level(OR=3.778) and IL-33 level(OR=4.665) were independent risk factors for bacterial infection in ACLF patients. In the Infection group, there were 40 cases that had a poor prognosis, and 11 cases with a good prognosis. A total of 23 cases with poor prognosis and 66 cases with good prognosis in the non-Infection group. Compared with the non-Infection group, the proportion of poor prognosis in the Infection group was significantly increased, and the difference was statistically significant(c2=36.227, P<0.001). In the infection group, when compared with good prognosis patients, the levels of serum PCT[(5.56±0.64) ng/mL vs.(4.44±0.52) ng/mL] and IL-33[(111.03±11.48) mg/mL vs.(57.12±8.99) mg/mL] in patients with poor prognosis were significantly higher(P<0.05). In the non-Infection group, when compared with good prognosis patients, the levels of serum PCT[(5.02±0.54) ng/mL vs.(3.89±0.43) ng/mL] and IL-33[(103.34±10.46) mg/mL vs.(45.34±7.98) mg/mL] in patients with poor prognosis were significantly higher(P<0.05). Compared with good prognosis group, the serum levels of PCT [(5.12±0.61)ng/mL vs.(4.18±0.48)ng/mL ] and IL-33 [(108.57±10.35)mg/mL vs.(50.33±8.56)mg/mL ] in the poor prognosis group were significantly increased, the differences were statistically significant(P<0.05). The ROC curve results showed that the AUC of IL-33, PCT and IL-33+PCT in the diagnosis of bacterial infection in ACLF patients were 0.895, 0.834, and 0.958, respectively. The diagnostic sensitivity and specificity were more than 85%. Besides, the AUC of IL-33+PCT in the diagnosis of bacterial infection in ACLF patients was significantly higher than IL-33 and PCT, respectively. The diagnostic sensitivity and specificity of IL-33+PCT were superior to IL-33 and PCT, respectively.Conclusion:IL-33 and PCT had a good clinical value in diagnosing bacterial infection and evaluating the incidence of poor prognosis in ACLF patients, and combination of the two indicators had a better clinical application value.更多还原