| Background and objective:Infectious diseases are one of the common human diseases and one of the main causes of mortality.At present,due to the low and time-consuming positive rate of pathogenic microorganisms,which cannot meet the clinical diagnostic needs,therefore,many scholars have started to study infection-related biomarkers in recent years.Biomarkers such as procalcitonin（PCT）and white blood cell count（WBC）are known to play an essential role in the diagnosis of bacterial infectious diseases.However,these markers,influenced by a number of factors,are not very specific and do not have independent diagnostic significance,which is why new biomarkers are constantly being explored.In recent years,human neutrophil lipocalin（HNL）has attracted much attention as a new infection-related biological marker and has become one of the new research focus in the field of infection,with more and more studies showing that HNL is significantly elevated in infectious diseases,while there are few relevant studies in China.This study investigates the value of HNL in the early diagnosis of acute bacterial diseases by measuring the expression levels of HNL,procalcitonin（PCT）and white blood cell count（WBC）in peripheral blood of patients with acute bacterial infectious disease to explore the value of HNL in the early diagnosis of acute bacterial diseases,and discusses whether there are differences in the degree of elevated HNL levels between different sites of infection and between those with positive and negative bacterial cultures.Serum HNL,PCT and WBC levels were also measured 96 hours after the use of antimicrobial drugs to assess the value of HNL in guiding the use of antimicrobial drugs.Methods:From March 2021 to September 2021,217 patients admitted to the Department of Respiratory Medicine,Department of Hepatobiliary Surgery,Department of Urology and Department of Intensive Care Medicine of China-Japan Union Hospital of Jilin University and diagnosed with acute bacterial infections were selected as the bacterial infection group,which was further divided into different groups according to the site of infection:cholecystitis group（59 cases）,lung infection group（102 cases）,urinary system infection group（27 cases）and other site infections group（29 cases）.Fifty healthy individuals who underwent physical examination at the Medical Examination Centre of China-Japan Union Hospital of Jilin University during the same period were randomly selected as the control group.Patients in the bacterial infection group had their peripheral blood HNL,PCT and WBC levels measured before the administration of antibiotics.And 91 patients in the infected group were selected to test the changes in HNL,PCT and WBC levels after 96 hours of antibiotic administration,after the degree of infection was confirmed to be reduced from clinical manifestations and imaging.Results:1.Serum HNL was significantly higher in the bacterial infection group was 233.80（218.02-252.71）ng/ml than in the control group 48.49（40.15-56.84）ng/ml,and the difference between the two groups was statistically significant（P<0.001）;serum PCT levels were significantly higher in the bacterial infection group 6.89（4.81-8.97）ng/ml,and the difference between the two groups was statistically significant（P=0.002）.The diagnostic efficacy of HNL,PCT and the combined indexes for bacterial infection in healthy people was 0.990,0.883 and 0.992,respectively,as analyzed by ROC curve and AUC.And the optimal threshold values for HNL and PCT were calculated to be 111.29ng/ml and0.175ng/ml respectively.2.The HNL in the cholecystitis group,the lung infection group,the urinary system infection group and the other sites of infection group were,in order,244.25（210.09-278.41）ng/ml,231.61（207.72-255.49）ng/ml,210.71（169.18-252.23）ng/ml,253.48（188.38-318.59）ng/ml;HNL levels were significantly higher in all subgroups than in the control group 48.49（40.15-56.84）ng/ml,with statistically significant differences（P<0.001）,while the differences in HNL levels between subgroups were not statistically significant（P>0.05）;PCT levels in each subgroup were:9.02（5.30-12.74）ng/ml,5.01（2.20-7.82）ng/ml,12.15（2.55-21.75）ng/ml,and 4.29（0.53-8.06）ng/ml,respectively,with PCT levels in each subgroup being significantly higher than those in the healthy group’s0.11（0.09-0.12）ng/ml,The differences between each subgroup and the healthy group were statistically significant P0.05）.3.The bacterial infection group was divided into negative and positive groups according to whether the bacterial was positive or not;the HNL levels in the two groups respectively were 229.60（208.22-250.98）ng/ml and 428.75（270.30-587.20）ng/ml;the HNL levels in both groups were higher than those in the control group’s 48.49（40.15-56.84）ng/m Lin both groups,with statistically significant differences（P<0.001）;although the HNL level was higher in the positive group than in the negative group,the difference was not statistically significant（P=0.053）;the PCT was significantly higher in the positive group was 9.22（5.03-13.41）ng/ml and in the negative group was5.11（3.11-7.15）ng/ml)than in the healthy group’s 0.11（0.09-0.12）ng/ml,with statistically significant differences between the positive and negative groups and the healthy group（P<0.001）,and statistically significant differences in PCT between the positive and negative groups（P=0.014）.4.Before using antibiotics,HNL、PCT and WBC are239.08±12.94ng/ml、8.86±1.79ng/ml and 14.24±0.95*10~9/L,after 96hours of antibiotic use,they were 153.07±10.61ng/ml、4.59±1.14ng/ml and 10.15±0.51*10~9/L,After 96 hours of antimicrobial drug use,HNL,PCT and WBC decreased significantly,indicating that these three declined as the degree of infection decreased,and based on the ROC curve,with an AUC of 0.73 for HNL,0.63 for PCT and 0.67 for WBC,the efficacy of the antimicrobial drugs was judged to be HNL>WBC>PCT in that order.Conclusion1.Serum HNL has higher diagnostic efficacy than PCT for the diagnosis of bacterial infections,the combination of HNL/PCT has higher efficacy compared to single inflammatory indicators.2.No significant difference between HNL and PCT in the diagnosis of different sites of infection,the levels of HNL and PCT do not identify the site of infection.3.The efficacy of HNL in infectious diseases,as compared to PCT,is not influenced by positive or negative bacterial results.4.HNL is expected to be an effective indicator to guide antibiotic application and antibiotic efficacy evaluation. |
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