Department of Clinical Laboratory, Anhui Provincial Hospital of Anhui Medical University of China, Hefei, Anhui Province, China.
Changchun Brother Biotech Co. Ltd., ChangChun, Jilin Province, China.
Clin Biochem. 2020 Jan;75:23-29. doi: 10.1016/j.clinbiochem.2019.10.003. Epub 2019 Oct 28.
Human neutrophil lipocalin (HNL) is used as a novel biomarker for infections. However, only a few studies have focused on the usefulness of HNL. The purpose of this study was to evaluate the diagnostic efficiency of HNL for identifying bacterial infections and to compare HNL with procalcitonin (PCT) and C-reactive protein (CRP).
Hospital patients with acute infections of bacterial origin (n = 439), viral origin (n = 71), and healthy volunteers (n = 67) were included in the study. The infection status of each patient was verified using microbiological, serological, and PCR testing. Additionally, CRP, HNL, and PCT levels were measured by established methods.
In distinguishing bacterial and viral infections, area under the curve (AUC) analysis showed that, with a value of 0.81 (95% CI, 0.76-0.86), HNL was superior to CRP at 0.73 (0.68-0.79) and PCT at 0.64 (0.58-0.70). Interestingly, the combination of HNL, PCT, and CRP improved the diagnostic potential significantly with an AUC of 0.86 (0.82-0.90, P < 0.05). Furthermore, when comparing different infection site subgroups with healthy patients, HNL levels were higher in all bacterial groups, albeit to widely varying degrees (P < 0.0001), and HNL reached a higher level in bloodstream and abdominal infections. CRP levels showed the same trend as HNL levels. PCT levels were significantly increased in bloodstream infections, abdominal infections, and in bacterial pneumonia (P < 0.0001), while no significant differences were found in soft tissue (P = 0.4378) or urinary tract infections (P = 0.423). There was no difference in HNL and CRP levels between patients with Gram-negative bacterial (GNB) or Gram-positive bacterial infections. However, compared with controls, PCT was only increased in GNB-infected patients.
HNL detection can help diagnose patients with infectious diseases, and the diagnostic efficacy of HNL is not affected by the infected site or by pathogenic bacterial species. The combination of HNL, PCT, and CRP has a superior performance at identifying bacterial infections compared with traditional biomarkers.
人中性粒细胞明胶酶相关脂质运载蛋白（HNL）可用作感染的新型生物标志物。然而，只有少数研究关注 HNL 的有用性。本研究旨在评估 HNL 用于识别细菌感染的诊断效率，并将其与降钙素原（PCT）和 C 反应蛋白（CRP）进行比较。
本研究纳入了 439 例细菌来源急性感染患者、71 例病毒来源急性感染患者和 67 名健康志愿者。通过微生物学、血清学和 PCR 检测验证每位患者的感染状态。此外，采用既定方法测定 CRP、HNL 和 PCT 水平。
在区分细菌和病毒感染方面，曲线下面积（AUC）分析显示，HNL 的 AUC 值为 0.81（95%CI，0.76-0.86），优于 CRP 的 0.73（0.68-0.79）和 PCT 的 0.64（0.58-0.70）。有趣的是，HNL、PCT 和 CRP 的联合显著提高了诊断潜能，AUC 值为 0.86（0.82-0.90，P<0.05）。此外，与健康患者比较不同感染部位亚组时，所有细菌组的 HNL 水平均升高，尽管程度差异很大（P<0.0001），血流感染和腹部感染中 HNL 水平更高。CRP 水平与 HNL 水平呈相同趋势。血流感染、腹部感染和细菌性肺炎中 PCT 水平显著升高（P<0.0001），而软组织感染（P=0.4378）和尿路感染（P=0.423）中 PCT 水平无显著差异。革兰氏阴性菌（GNB）或革兰氏阳性菌感染患者的 HNL 和 CRP 水平无差异。然而，与对照组相比，仅 GNB 感染患者的 PCT 升高。
HNL 检测有助于诊断感染性疾病患者，HNL 的诊断效果不受感染部位或致病性细菌种类的影响。HNL、PCT 和 CRP 的联合在识别细菌感染方面比传统生物标志物具有更好的性能。
