人类白细胞抗原-DR/CD4<sup>+</sup>T淋巴细胞 白细胞介素6联合降钙素原预测ICU重症急性胰腺炎继发感染效能及对抗菌药物合理使用的指导价值

doi:10.3969/j.issn.1006-6233.2024.05.025

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Abstract Objective: To investigate the diagnostic efficacy and guidance value for rational use of antimicrobials of human leukocyte antigen-DR/CD4⁺ T lymphocytes (HLA-DR/CD4⁺), interleukin-6 (IL-6), and procalcitonin (PCT) in patients with secondary infection of severe acute pancreatitis (SAP) in the ICU. Methods: A total of 80 patients with SAP admitted to the ICU of our hospital from May 2020 to December 2023 were enrolled in the study. Patients were divided into an infection group (n=43) and a non-infection group (n=37) according to whether or not they had secondary infection. Clinical data of all patients were collected, including general information, laboratory indicators, and antimicrobial treatment information. The general information and laboratory indicators of the two groups were compared. Logistic regression analysis was used to analyze the independent risk factors for secondary infection in severe SAP, and receiver operating characteristic (ROC) curve analysis was used to evaluate the efficacy of serum HLA-DR/CD4⁺, IL-6, and PCT in predicting secondary infection in SAP. Results: The APACHE II score in the infection group was higher than that in the non-infection group (P<0.05). There was no significant difference in gender, age, etiology, and complications (hypertension, type 2 diabetes, and hyperlipidemia) between the two groups (P> 0.05). The levels of lipase, IL-6, and PCT in the infection group were higher than those in the non-infection group (P<0.05), and the level of HLA-DR/CD4⁺ was lower than that in the non-infection group (P<0.05). Elevated lipase (OR=2.354, 95% CI 1.491~3.716), elevated HLA-DR/CD4⁺ (OR=3.508, 95% CI 1.283~9.588), elevated IL-6 (OR=4.284, 95% CI 1.469~12.493) and elevated PCT (OR=5.743, 95% CI 1.530~21.563) were all independent risk factors for secondary infection in SAP (P<0.05). The AUC values of serum HLA-DR/CD4⁺, IL-6, PCT and the three combined for diagnosing SAP secondary infection were 0.809, 0.778, 0.819 and 0.959, respectively, indicating a certain predictive value. The AUC value and diagnostic efficacy of combined diagnosis were significantly higher than those of single HLA-DR/CD4⁺ (z=3.161, P=0.002), IL-6 (z=3.822, P<0.001) and PCT (z=3.346, P=0.001) diagnosis. The level of serum HLA-DR/CD4⁺ in the localized infection group was higher than that in the severe infection group, while the levels of IL-6 and PCT were both lower than those in the severe infection group (P<0.05). The duration of antimicrobial use, ICU stay, and total hospital stay in the localized infection group were all significantly shorter than those in the severe infection group (P<0.05). Conclusion: Elevated HLA-DR/CD4⁺, IL-6, and PCT are all independent risk factors for secondary infection in SAP and can effectively predict secondary infection in SAP.

Key words： Acute pancreatitis HLA-DR/CD4⁺ il-6 PCT Infection Antimicrobials

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.05.025 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I5/838

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