Predictive value of combined detection of serum procalcitonin, serum high mobility group protein B1 and prealbumin in postoperative urinary system infection
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摘要: 目的 探讨血清降钙素原(procalcitoni，PCT)、高迁移率族蛋白B1(high mobility group protein B1，HMGB1)及前白蛋白(prealbumin，PA)联合检测在泌尿系统术后感染中的预测价值。方法 选取2018年1月—2021年2月在首都医科大学附属北京友谊医院接受泌尿系统手术的152例患者为研究对象，根据患者术后感染的情况分为感染组(62例)和未感染组(90例)。检测患者术前血清PCT、HMGB1及PA水平，采用受试者工作特征曲线(receiver operating characteristic curve，ROC)研究患者上述指标水平对术后感染的预测价值。结果 感染组血清PCT、HMGB1明显高于未感染组[(3.56±1.01) ng/mL vs.(0.98±0.26) ng/mL，(16.64±4.73) ng/mL vs.(2.65±0.51) ng/mL]，而PA水平明显低于未感染组[(164.08±30.94) mg/L vs.(185.16±36.05) mg/L]，差异有统计学意义(P< 0.001)。Logistic回归拟合回归方程为Logit(P)=1.252+0.685PCT+0.589HMGB1-0.962PA。HMGB1诊断泌尿系统术后感染的截断值为12.78 ng/mL，灵敏度为88.7%，特异度为58.9%，ROC曲线下面积为0.805(95%CI：0.730~0.879)；PCT诊断截断值为2.69 ng/mL，灵敏度为82.3%，特异度为80.0%，ROC曲线下面积为0.816(95%CI：0.743~0.889)；PA诊断截断值为168.65 mg/L，灵敏度为95.2%，特异度为61.1%，ROC曲线下面积为0.826(95%CI：0.763~0.889)；血清PCT、HMGB1及PA联合检测的灵敏度为85.5%，特异度为78.9%，ROC曲线下面积为0.896(95%CI：0.848~0.944)，联合检测的ROC曲线下面积显著高于各单项检测(P< 0.05)。结论 血清PCT、HMGB1在泌尿系统术后感染患者中呈显著高表达，PA水平显著降低，且三者联合检测对术后感染具有较高预测价值。Abstract: Objective To investigate the predictive value of combined detection of serum procalcitonin (PCT), serum high mobility group protein B1(HMGB1) and prealbumin(PA) in postoperative urinary system infections.Methods From January 2018 to February 2021, 152 patients who underwent urinary system surgery in Beijing Friendship Hospital Affiliated to Capital Medical University were selected as the research objects. According to the postoperative infection of the patients, they were divided into 62 cases in the infected group and 90 cases in the non-infected group. The patient's serum PCT, HMGB1 and PA levels before surgery were detected, and the receiver operating characteristic curve (ROC) was used to study the predictive value of the patient's above-mentioned index levels for postoperative infection.Results The serum PCT and HMGB1 of the infection group were significantly higher than those of the non-infected group[(3.56±1.01) ng/mL vs.(0.98±0.26) ng/mL, (16.64±4.73) ng/mL vs.(2.65±0.51) ng/mL], while the PA level was significantly lower than that of the non-infected group[(164.08±30.94) mg/L vs. (185.16±36.05) mg/L]. The difference was statistically significant (P< 0.001). The logistic regression fitting regression equation is Logit (P)=1.252+0.685PCT+0.589HMGB1-0.962PA. The cut-off value of HMGB1 for diagnosing postoperative urinary system infection was 12.78 ng/mL, and the sensitivity was 88.7%. The specificity was 58.9%, and the area under the ROC curve was 0.805 (95%CI: 0.730-0.879). The diagnosis cut-off value for PCT was 2.69 ng/mL, and the sensitivity was 82.3%. The specificity was 80.0%, and the area under the ROC curve was 0.816 (95%CI: 0.743-0.889). The diagnostic cut-off value of PA was 168.65 mg/L, and the sensitivity was 95.2%. The specificity was 61.1%, and the area under the ROC curve was 0.826 (95%CI: 0.763-0.889). The sensitivity of the combined detection of serum PCT, HMGB1 and PA was 85.5%, the specificity was 78.9%, and the area under the ROC curve was 0.896 (95%CI: 0.848-0.944). The area under the ROC curve of the combined test was significantly higher than that of the individual tests (P< 0.05).Conclusion Serum PCT and HMGB1 highly express in patients with postoperative infection of the urinary system, but the level of PA is significantly low. The combined detection of the three has a high predictive value for postoperative infection.
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表 1 两组患者血清PCT、HMGB1及PA水平比较
X±S 组别 例数 HMGB1/ (ng·mL-1) PCT/ (ng·mL-1) PA/ (mg·L-1) 感染组 62 16.64±4.73 3.56±1.01 164.08±30.94 未感染组 90 2.65±0.51 0.98±0.26 185.16±36.05 t 23.196 19.670 3.749 P值 ＜0.001 ＜0.001 ＜0.001 
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表 2 血清PCT、HMGB1及PA检查诊断结果
组别 例数 HMGB1 PCT PA 阴性 阳性 阴性 阳性 阴性 阳性 感染组 62 7 55 11 51 3 59 未感染组 90 53 37 72 18 55 35
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表 3 血清PCT、HMGB1及PA联合检测的诊断模型
影响因素 β SE Wald χ2 OR 95%CI P值 HMGB1 0.614 0.245 6.281 1.848 1.143~2.987 0.012 PCT 0.823 0.342 5.791 2.277 1.165~4.452 0.016 PA -0.962 0.401 5.755 0.382 0.174~0.839 0.016
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表 4 血清PCT、HMGB1及PA单独和联合检测的灵敏度、特异度比较
诊断方法 灵敏度 特异度 阳性预测值 阴性预测值 约登指数 AUC 95%CI HMGB1 88.7% 58.9% 59.8% 88.3% 0.476 0.805 0.730~0.879 PCT 82.3% 80.0% 73.9% 86.7% 0.623 0.816 0.743~0.889 PA 95.2% 61.1% 62.8% 94.8% 0.563 0.826 0.763~0.889 联合诊断 85.5% 78.9% 73.6% 88.8% 0.644 0.896 0.848~0.944
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