乙肝相关性慢加急性肝衰竭患者降钙素原水平与病情转归的相关性

发布时间：2018-03-31 08:58

本文选题：乙肝　切入点：慢加急性肝衰竭　出处：《广东医学》2017年21期

【摘要】：目的分析乙肝相关性慢加急性肝衰竭(HBV-ACLF)患者治疗前后降钙素原(PCT)水平的差值(ΔPCT)与病情转归的相关性。方法观察组为90例HBV-ACLF患者,空白对照组为30例乙肝肝硬化代偿期患者。观察组检测治疗前(基线水平)、治疗后的肝脏生化、凝血功能及PCT并计算MELD评分,将治疗2周时MELD评分下降≥3分患者记为好转,下降3分记为无好转。空白对照组只检查上述指标1次作为基线水平的评估。分析观察组患者治疗前后PCT水平的变化及其差值(ΔPCT)与MELD评分、总胆红素、国际标准化比值、血肌酐的相关性。对观察组患者90 d死亡率作预测分析,比较PCT、ΔPCT、MELD评分及其联合应用的曲线下面积(AUC),评估上述指标的预测价值。结果早期HBV-ACLF治疗好转组PCT的基线水平较治疗无好转组高[(1.08±0.82)mg/L vs(0.65±0.36)mg/L,P=0.007],且治疗好转组于2周时测PCT较基线水平明显下降,而治疗无好转组反而升高,ΔPCT分别为(-0.48±0.66)mg/L及(0.2±0.56)mg/L,组间比较差异有统计学意义(P0.001)。而中期HBV-ACLF患者治疗好转组及治疗无好转组的PCT基线水平无明显差异[(0.6±0.32)vs.(0.58±0.31)mg/L,P=0.980],两组患者治疗前后的PCT变化不明显,ΔPCT分别为(-0.07±0.37)mg/L及(0.01±0.39)mg/L,组间比较差异无统计学意义(P=0.959)。观察组HBV-ACLF患者治疗前后的ΔPCT与ΔMELD分值、ΔTB呈中度相关(相关系数分别为0.430及0.528,P均0.001),但与ΔCr及ΔINR无相关性。以受试者工作特征曲线(ROC)对观察组患者入院90 d死亡率作预测分析表明:在早期HBV-ACLF患者中,以ΔPCT联合MELD的AUC较单独使用MELD评分的要高,分别为0.80和0.69,P=0.054,处于临界值。结论早期HBV-ACLF患者的PCT水平高者短期(2周)疗效好,其ΔPCT水平与其病情转归相关,以ΔPCT水平联合MELD评分对于患者的90 d死亡率有预测价值。
[Abstract]:Objective to analyze the correlation between the difference (螖 PCT) and the prognosis of patients with chronic hepatitis B associated with acute hepatic failure (HBV-ACLF) before and after treatment. Methods 90 patients with HBV-ACLF were enrolled in the study group. In the control group, the liver biochemistry, coagulation function and PCT were measured before and after treatment, and the MELD scores were calculated. The patients whose MELD score decreased more than 3 points at 2 weeks after treatment were recorded as improved. The decrease of 3 points was recorded as no improvement. The blank control group only checked the above indexes once as the baseline level evaluation. The changes of PCT level and its difference (螖 PCT) and MELD score, total bilirubin, international standardized ratio before and after treatment in the observation group were analyzed. Correlation of serum creatinine. The 90 day mortality of patients in the observation group was predicted and analyzed. Compared with the score of PCT, 螖 PCT meld and the area under the curve used in combination, we evaluated the predictive value of the above indexes. Results the baseline level of PCT in the early HBV-ACLF group was higher than that in the non-improvement group [1.08 卤0.82)mg/L vs(0.65 卤0.36 mg / L P0. 007], and PCT was measured in the improved group at 2 weeks. The line level has dropped significantly, The 螖 PCT was -0.48 卤0.48 卤0.66)mg/L and 0.2 卤0.56 mg / L, respectively, and the difference between the two groups was statistically significant (P 0.001), but there was no significant difference in the baseline level of PCT between the two groups before and after treatment [0.6 卤0.32)vs.(0.58 卤0.31 mg / L P 0.980]. There was no significant change in PCT, 螖 PCT was -0.07 卤0.37)mg/L and 0.01 卤0.39 mg / L, respectively. There was no significant difference between the two groups. The 螖 PCT and 螖 MELD scores of HBV-ACLF patients in the observation group before and after treatment were moderately correlated (correlation coefficients were 0.430 and 0.528, P 0.001, respectively), but there was no correlation with 螖 Cr and 螖 INR. Using the operating characteristic curve of subjects, the mortality of 90 days after admission in the observation group was predicted. The results showed that in the early stage of HBV-ACLF, the mortality rate of the patients in the observation group was higher than that in the control group. The AUC with 螖 PCT combined with MELD was significantly higher than that with MELD score (0.80 and 0.69 P0.054, respectively). Conclusion the high PCT level in early HBV-ACLF patients had a good curative effect for 2 weeks. The 螖 PCT level was correlated with the outcome of the disease. 螖 PCT level combined with MELD score can predict 90 day mortality.
【作者单位】：广东医学院附属深圳市第三人民医院肝病科;
【分类号】：R512.62;R575.3

【相似文献】