目的:分析人类白细胞抗原-DR/CD4+T 淋巴细胞(HLA-DR/CD4+)、白细胞介素 6(IL-6)及降钙素原(PCT)在ICU重症急性胰腺炎(SAP)继发感染患者中的诊断效能及对抗菌药物合理使用的指导价值。方法:2020 年5 月至2023 年12 月在我院 ICU 收治的 SAP 患者 80 例纳入研究。按照是否继发感染将患者分为感染组(n=43)及未感染组(n=37)。收集所有患者临床资料，包括一般资料、实验室指标、抗菌治疗情况。比较两组一般资料及实验室指标，采用 Logistic 回归分析重症 SAP 继发感染的独立危险因素，采用受试者工作特征曲线(ROC)分析血清 HLA-DR/CD4+、IL-6 及 PCT 预测SAP 继发感染的效能。结果:感染组APACHE Ⅱ评分大于未感染组(P<0。05)。两组性别、年龄、病因、并发症(高血压、2 型糖尿病及高脂血症)情况比较无显著差异(P>0。05)。感染组脂肪酶、IL-6 及 PCT水平高于未感染组(P<0。05)，HLA-DR/CD4+水平低于未感染组(P<0。05)。脂肪酶高表达(OR=2。354，95%CI 1。491～3。716)、HLA-DR/CD4+高表达(OR=3。508，95%CI 1。283～9。588)、IL-6 高表达(OR=4。284，95%CI 1。469～12。493)及PCT高表达(OR=5。743，95%CI 1。530～21。563)均是 SAP 继发感染的独立危险因素(P<0。05)。血清HLA-DR/CD4+、IL-6 及 PCT 及三者联合诊断 SAP 继发感染的AUC值分别为0。809、0。778、0。819 及0。959，具有一定预测价值。联合诊断的AUC值及诊断效能明显大于单独HLA-DR/CD4+(z=3。161，P=0。002)、IL-6(z=3。822，P<0。001)及 PCT(z=3。346，P=0。001)诊断。局部感染组血清HLA-DR/CD4+水平高于严重感染组，IL-6 及PCT水平均低于严重感染组(P<0。05)。局部感染组抗菌药物使用时间、ICU住院时间及总住院时间均较严重感染组显著缩短(P<0。05)。结论:HLA-DR/CD4+高表达、IL-6 高表达及 PCT 高表达均是 SAP 继发感染的独立危险因素，可有效预测SAP 继发感染。
Efficacy of HLA-DR/CD4+IL-6 and PCT in Predicting Secondary Infection in ICU Patients with Severe Acute Pancreatitis and Guidance for Rational Use of Antimicrobials
Objective:To investigate the diagnostic efficacy and guidance value for rational use of anti-microbials 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 col-lected,including general information,laboratory indicators,and antimicrobial treatment information.The gen-eral 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 high-er than that in the non-infection group(P<0.05).There was no significant difference in gender,age,etiolo-gy,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 in-fection 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 pre-dict secondary infection in SAP.
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