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中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 235 -240. doi: 10.3877/cma.j.issn.1674-1358.2020.03.010

所属专题： 文献；

论著

血清正五聚蛋白3水平对急性重症胰腺炎患者并发细菌感染的早期诊断价值
夏家惠1,†(), 伍永立1   
  1. 1. 516000　惠州市，惠州市中心人民医院重症医学科
  • 收稿日期:2019-08-15 出版日期:2020-06-15
  • 通信作者: 夏家惠
  • 基金资助:
    惠州市科技计划项目(No. 2017Y029)

Early diagnostic value of serum pentamerin 3 in patients with acute severe pancreatitis complicated with bacterial infection

Jiahui Xia1,†(), Yongli Wu1   

  1. 1. Department of Intensive Medicine, Huizhou Central People’s Hospital, Huizhou 516000, China
  • Received:2019-08-15 Published:2020-06-15
  • Corresponding author: Jiahui Xia
  • About author:
    Corresponding author: Xia Jiahui, Email:
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引用本文：

夏家惠, 伍永立. 血清正五聚蛋白3水平对急性重症胰腺炎患者并发细菌感染的早期诊断价值[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(03): 235-240.

Jiahui Xia, Yongli Wu. Early diagnostic value of serum pentamerin 3 in patients with acute severe pancreatitis complicated with bacterial infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(03): 235-240.

目的

探讨血清中正五聚蛋白3（PTX3）水平对重症急性胰腺炎合并细菌感染者的早期诊断价值。

方法

选取2017年4月至2019年4月于惠州市中心人民医院消化内科治疗的重症急性胰腺炎患者106例，根据是否合并细菌感染分为合并细菌感染组（45例）和未合并细菌感染者（61例），另选取同期64例体检健康者为对照组，通过酶联免疫吸附法（ELISA）检测入组研究对象血清PTX3和降钙素原（PCT）水平，采用二元Logistic回归分析影响重症急性胰腺炎合并细菌感染的危险因素，绘制受试者工作特征曲线（ROC）评估血清PTX3和PCT水平对重症急性胰腺炎合并细菌感染的诊断价值。

结果

与对照组相比，未合并细菌感染组患者血清PTX3和PCT水平差异无统计学意义（t = 1.747、U = 0.123，P = 0.083、0.903），合并细菌感染组患者血清PTX3和PCT水平显著升高（t = 10.128、U = 8.919，P均< 0.001）；与未合并细菌感染组患者相比，合并细菌感染组患者血清PTX3和PCT水平显著升高（t = 8.438、U = 8.830，P均< 0.001）；二元Logistic回归分析显示血清PTX3和PCT水平为重症急性胰腺炎患者合并细菌感染的独立危险因素（OR = 2.491、1.576，P均< 0.001）。ROC曲线显示，血清PTX3水平诊断重症急性胰腺炎患者合并细菌感染曲线下面积为0.830（敏感度和特异性分别为82.2%和85.2%）；血清PCT水平诊断重症急性胰腺炎合并细菌感染曲线下面积为0.865（敏感度和特异性分别为88.9%和88.5%），与PCT相比，血清PTX3水平对重症急性胰腺炎合并细菌感染的曲线下面积差异无统计学意义（Z = 0.581，P = 0.561）。

结论

血清PTX3水平可能作为重症急性胰腺炎患者并发细菌感染的生物学指标。

关键词: 重症急性胰腺炎, 正五聚蛋白3, 细菌感染, 降钙素原
Objective

To investigate the early diagnostic value of serum pentamerin 3 (PTX3) in patients with severe acute pancreatitis complicated with bacterial infection.

Methods

Total of 106 patients with severe acute pancreatitis treated in the Department of Digestive Medicine, Huizhou Central People’s Hospital from April 2017 to April 2019 were collected, and were divided into bacterial infection group (45 cases) and non-bacterial infection group (61 cases) according to whether complicated with bacterial infection or not. While 64 healthy persons were selected as control group during the same period. The levels of serum PTX3 and procalcitonin (PCT) were detected by enzyme-linked immunosorbent assay (ELISA), the risk factors of severe acute pancreatitis complicated with bacterial infection were analyzed by multiple Logistic regression, the diagnostic values of serum PTX3 and PCT levels in severe acute pancreatitis complicated with bacterial infection were compared by the receiver operating characteristic curve (ROC).

Results

There was no significant difference in serum PTX3 and PCT levels between the non-bacterial infection group and the control group (t = 1.747, P = 0.083; U = 0.123, P = 0.903), the serum PTX3 and PCT levels in the bacterial infection group were significantly higher than those of the control group (t = 10.128, U = 8.919; all P < 0.001). Compared with non-bacterial infection group, the levels of PTX3 and PCT in the group with bacterial infection increased significantly, with significant differences (t = 8.438, U = 8.830; all P < 0.001). Binary Logistic regression analysis showed that serum PTX3 and PCT levels were independent risk factors of bacterial infection in patients with severe acute pancreatitis (OR = 2.491, 1.576; all P < 0.001). ROC curve showed that the area under the curve of serum PTX3 level was 0.830 (the sensitivity and specificity were 82.2% and 85.2%); the area under the curve of serum PCT level for the diagnosis of severe acute pancreatitis complicated with bacterial infection was 0.865 (the sensitivity and specificity were 88.9% and 88.5%), and there was no significant difference in the area under curve of serum PTX3 level and PCT level for severe acute pancreatitis complicated with bacterial infection (Z = 0.581, P = 0.561).

Conclusion

Serum PTX3 level may be a biological indicator of bacterial infection in patients with severe acute pancreatitis.

Key words: Severe acute pancreatitis, Pentamerin 3, Bacterial infection, Procalcitonin
表1 各组研究对象的临床资料
组别 例数 性别（男/女，例） 年龄（ ± s，岁） 病程（ ± s，月） 白细胞计数（ ± s，× 109/L） APACHE Ⅱ评分（ ± s）
对照组 64 39/25 45.12 ± 5.12 — 5.23 ± 0.98 —
未合并细菌感染组 61 38/23 45.53 ± 5.24 2.13 ± 0.35 13.54 ± 3.57a 10.64 ± 2.13
合并细菌感染组 45 28/17 45.67 ± 5.22 2.25 ± 0.31 16.71 ± 4.41ab 17.05 ± 4.16
统计量 ? χ2 = 0.030 F = 0.173 — F = 197.747 —
P值 ? 0.985 0.842 — < 0.001 —
t1值 ? 0.024 0.442 — 17.930 —
P1值 ? 0.876 0.659 — < 0.001 —
t2值 ? 0.018 0.548 — 20.166 —
P2值 ? 0.892 0.585 — < 0.001 —
t3值 ? < 0.001 0.136 1.830 4.087 10.347
P3值 ? 0.994 0.892 0.070 < 0.001 < 0.001
表2 各组研究对象的血清PTX3和PCT水平
组别 例数 PTX3（ ± s，μg/L） PCT [M（P25，P75），ng/ml]
对照组 64 6.12 ± 1.22 0.02（0.01，0.04）
未合并细菌感染组 61 6.52 ± 1.34 0.03（0.01，0.04）
合并细菌感染组 45 9.31 ± 2.06 7.18（0.46，13.71）
统计量 ? F = 64.903 H = 101.254
P值 ? < 0.001 < 0.001
t1/U1值 ? 1.747 0.123
P1值 ? 0.083 0.903
t2/U值 ? 10.128 8.919
P2值 ? < 0.001 < 0.001
t3/U值 ? 8.438 8.830
P3值 ? < 0.001 < 0.001
表3 二元Logistic回归分析重症急性胰腺炎合并细菌感染危险因素
影响因素 β值 SE值 Wald χ2值 P值 OR值 95%CI值
性别 －0.634 0.437 2.110 0.146 0.530 0.225～1.248
年龄 －0.625 0.371 2.842 0.091 0.535 0.258～1.107
白细胞计数 －0.092 0.090 1.047 0.306 0.912 0.764～1.087
PTX3 0.913 0.437 4.355 < 0.001 2.491 2.131～2.914
PCT 0.455 0.316 2.070 < 0.001 1.576 1.126～2.205
图1 血清PCT和PTX3水平对重症胰腺炎合并细菌感染的诊断价值
表4 血清PCT和PTX3水平对重症胰腺炎合并细菌感染的诊断价值
诊断指标 AUC 截断值 灵敏度（%） 特异性（%）
PTX3 0.830 9.78 μg/L 82.2 85.2
PCT 0.865 3.84 ng/ml 88.9 88.5
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