HNL、PCT 、TRAIL对血液病患者血流感染的诊断价值

doi:10.3969/j.issn.1673-8640.2020.12.017

摘要/Abstract

摘要：

目的探讨人中性粒细胞载脂蛋白（HNL）、降钙素原（PCT）、肿瘤坏死因子相关凋亡诱导配体（TRAIL）在诊断血液病患者血流感染中的价值。方法选取血培养阳性的血液病患者（血流感染组）和血培养阴性的血液病患者（非血流感染组）各120例,检测所有患者的HNL、PCT、TRAIL水平。采用受试者工作特征（ROC）曲线评价各项指标诊断血流感染的效能。结果血流感染组HNL、PCT水平显著高于非血流感染组（P<0.000 1）,TRAIL水平显著低于非血流感染组（P<0.000 1）。采用Logistic回归分析建立HNL、PCT和TRAIL的联合检测模型。ROC曲线分析结果显示,HNL、PCT、TRAIL及联合检测模型诊断血流感染的ROC曲线下面积（AUC）分别为0.993、0.849、0.938、0.996,最佳临界值分别为60.15 ng/mL、0.85 ng/mL、104.57 pg/mL、0.34,敏感性分别为100%、61.7%、90.8%、100%,特异性分别为97.5%、91.7%、84.2%、98.4%。结论 HNL、PCT、TRAIL诊断血液病患者血流感染有较好的价值。

关键词: 人中性粒细胞载脂蛋白, 降钙素原, 肿瘤坏死因子相关凋亡诱导配体, 血流感染

Abstract:

Objective To evaluate the diagnostic roles of human neutrophil lipocalin（HNL）,procalcitonin（PCT） and tumour necrosis factor-related apoptosis-inducing ligand（TRAIL） in patients with hematological diseases. Methods A total of 120 blood culture-positive hematologic patients（blood stream infection group） and 120 blood culture-negative hematologic patients（non-blood stream infection group） were enrolled,and the levels of HNL,PCT and TRAIL were determined. The efficiency of each index in diagnosing blood stream infection was evaluated by receiver operating characteristic（ROC） curve. Results The levels of HNL and PCT were higher in bloodstream infection group than those in non-bloodstream infection group（P<0.000 1）,and the level of TRAIL was lower than that in non-bloodstream infection group（P<0.000 1）. Logistic regression analysis was used to list the combined determination models of HNL,PCT and TRAIL,and ROC curve analysis showed that the AUC of HNL,PCT,TRAIL and the combined determination models for blood stream infection were 0.993,0.849,0.938 and 0.996,respectively,and the optimal cut-off values were 60.15 ng/mL,0.85 ng/mL,104.57 pg/mL,0.34,with the sensitivities of 100%,61.7%,90.8% and 100% and the specificities of 97.5%,91.7%,84.2% and 98.4%,respectively. Conclusions HNL,PCT and TRAIL play roles in the diagnosis of bloodstream infection in hematologic patients.

Key words: Human neutrophil lipocalin, Procalcitonin, Tumor necrosis factor-related apoptosis-inducing ligand, Bloodstream infection

中图分类号:

R446.1

刘瑞来, 商安全, 关明. HNL、PCT 、TRAIL对血液病患者血流感染的诊断价值[J]. 检验医学, 2020, 35(12): 1277-1280.

LIU Ruilai, SHANG Anquan, GUAN Ming. Diagnostic roles of HNL,PCT and TRAIL in bloodstream infection of patients with hematological diseases[J]. Laboratory Medicine, 2020, 35(12): 1277-1280.

图/表 3

参考文献 20

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组别	例数	HNL/（ng/mL）	PCT/（ng/mL）	TRAIL/（pg/mL）
血流感染组	120	89.12（74.91~117.68）	1.00（0.59~1.65）	55.97（20.74~96.42）
非血流感染组	120	32.26（29.60~39.03）	0.40（0.21~0.63）	126.51（108.12~151.69）
Z值		-13.19	-9.35	-11.72
P值		0.000	0.000	0.000

组别	例数	HNL/（ng/mL）	PCT/（ng/mL）	TRAIL/（pg/mL）
血流感染组	120	89.12（74.91~117.68）	1.00（0.59~1.65）	55.97（20.74~96.42）
非血流感染组	120	32.26（29.60~39.03）	0.40（0.21~0.63）	126.51（108.12~151.69）
Z值		-13.19	-9.35	-11.72
P值		0.000	0.000	0.000

项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	阴性预测值/%	阳性预测值/%	约登指数
HNL	0.993（0.972~0.999）	60.15 ng/mL	100.0	97.5	100.0	97.6	0.975
PCT	0.849（0.797~0.892）	0.85 ng/mL	61.7	91.7	70.5	88.1	0.533
TRAIL	0.938（0.899~0.965）	104.57 pg/mL	90.8	84.2	90.2	85.2	0.750
联合检测模型	0.996（0.978~1.000）	0.34	100.0	98.3	100.0	98.4	0.983

项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	阴性预测值/%	阳性预测值/%	约登指数
HNL	0.993（0.972~0.999）	60.15 ng/mL	100.0	97.5	100.0	97.6	0.975
PCT	0.849（0.797~0.892）	0.85 ng/mL	61.7	91.7	70.5	88.1	0.533
TRAIL	0.938（0.899~0.965）	104.57 pg/mL	90.8	84.2	90.2	85.2	0.750
联合检测模型	0.996（0.978~1.000）	0.34	100.0	98.3	100.0	98.4	0.983