WBC、PCT及IL-6水平对肾综合征出血热患者病情严重程度的预测价值

Prediction Value of WBC, PCT and IL-6 Levels in the Severity of Hemorrhagic Fever with Renal Syndrome

摘要: 目的：探讨白细胞计数(WBC)、降钙素原(procalcitonin, PCT)和白细胞介素-6 (interleukin-6, IL-6)水平对肾综合征出血热患者病情严重程度的预测价值。方法：本研究选取2021年至2023年在空军军医大学第二附属医院急诊科确诊为HFRS患者为研究对象，共118例。参照《肾综合征出血热诊疗陕西省专家共识》(2019)，将患者分为轻型、中型、重型和危重型，其中将轻型与中型定义为轻症组(n = 50)，重型与危重型定义为重症组(n = 68)。比较WBC、PCT和IL-6水平在不同组间的表达差异；分析WBC、PCT和IL-6预测HFRS病情严重程度的敏感度及特异度。结果：重症组血清WBC、PCT和IL-6水平均高于轻症组，差异均有统计学意义(P < 0.050)。进行logistic回归分析筛查出PCT和IL-6是患者进展为危重症的独立影响因子(均P < 0.050)。进一步分析PCT、IL-6及其联合指标对重症HFRS预警效能的曲线下面积(area under curve, AUC)分别为0.872，0.768，最佳阈值分别为8.220 ng/ml、42.670 pg/ml，联合检测AUC为0.883，敏感度为36.8%，特异度为90.0%，优于单个实验室检查指标的检测。结论：WBC、PCT和IL-6能早期预测HFRS病情严重程度，其中的PCT和IL-6水平为独立危险因素，其联合指标有更好的特异度。

Abstract: Objective: To investigate the value of leukocyte count (WBC), procalcitonin (PCT) and interleukin-6 (IL-6) levels in predicting the severity of hemorrhagic fever with renal syndrome. Methods: A total of 118 patients diagnosed with HFRS in the emergency Department of the Second Affiliated Hospital of Air Force Med Prediction value of WBC, PCT and IL-6 levels in the severity of hemorrhagic fever with renal syndromeical University from 2021 to 2023 were selected as the study objects. According to the Expert Consensus on the Diagnosis and Treatment of hemorrhagic fever with renal Syndrome in Shaanxi Province (2019), the patients were divided into mild, medium, severe and critical types, in which the mild and medium types were defined as the mild group (n = 50), and the severe and critical types as the severe group (n = 68). The expression of WBC, PCT and IL-6 in different groups were compared. The sensitivity and specificity of WBC, PCT and IL-6 in predicting the severity of HFRS were analyzed. Results: The levels of serum WBC, PCT and IL-6 in severe group were higher than those in mild group, with statistical significance (P < 0.050). Logistic regression analysis showed that PCT and IL-6 were independent factors for progression to critical illness (both P < 0.050). The area under curve (AUC) of PCT, IL-6 and their combined indicators for warning severe HFRS was 0.872 and 0.768, respectively, and the optimal threshold was 8.220 ng/ml and 42.670 pg/ml, respectively, and the AUC of combined detection was 0.883. The sensitivity was 36.8%, and the specificity was 90.0%, which was better than that of a single laboratory test index. Conclusion: WBC, PCT and IL-6 can predict the severity of HFRS early. PCT and IL-6 levels are independent risk factors, and their combined indexes have better specificity.