HBV相关慢加急性肝衰竭患者外周血皮质醇水平及临床意义

发布时间：2018-06-08 05:08

本文选题：慢性 + 乙型肝炎　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:探讨HBV相关慢加急性肝衰竭患者外周血中皮质醇的水平与病情严重程度及预后的关系。方法:入选2016年1月至2016年11月期间就诊于新疆医科大学第一附属医院感染性疾病中心30例HBV相关慢加急性肝衰竭患者,12例重度慢性乙型病毒性肝炎患者,同时选取20例健康对照组,分别检测患者10:00、18:00、凌晨2:00三个时间段外周血皮质醇浓度,同时检测患者肝功能、凝血功能、肌酐等实验室指标,比较各组间三个时间段皮质醇浓度,并将皮质醇与INR、PTA、TBiL、A ST、ALT、MELD评分进行相关性分析。结果:HBV相关慢加急性肝衰竭组发生肾上腺皮质功能不全约43%(13/30);HBV相关慢加急性肝衰竭组、重度慢性乙型病毒性肝炎组、健康正常组凌晨2:00外周血皮质醇浓度分别为(161.32±104.18)nmol/L、(93.53±54.33)nmol/L、(19.06±8.11)nmol/L,呈逐渐递减趋势,三组间比较差异有统计学意义(F=20.65,P0.01);HBV相关慢加急性肝衰竭组凌晨2:00外周血皮质醇浓度与PTA呈负相关(r=-0.383,P0.05),与INR(r=0.406,P0.05)、MEL D评分(r=0.421,P0.05)呈正相关,与TBi L、AST、ALT无明显相关性(P0.05)。HBV相关慢加急性肝衰竭死亡组凌晨2:00外周血皮质醇浓度(205.43±110.62)nmo l/L明显高于生存组外周血皮质醇浓度(122.72±83.51)nmol/L,差异有统计学意义(t=2.33,P0.05);该ROC曲线下面积为0.763,有统计学意义(P0.05)。结论:HBV相关慢加急性肝衰竭患者存在神经-内分泌-免疫系统变化,具有较高的肾上腺皮质功能不全发生率。HBV相关慢加急性肝衰竭患者凌晨2:00外周血皮质醇浓度明显升高且与疾病严重程度以及患者预后有关。
[Abstract]:Objective: to investigate the relationship between the level of cortisol in peripheral blood and severity and prognosis of patients with HBV associated chronic and acute liver failure. Methods: from January 2016 to November 2016, 12 patients with severe chronic viral hepatitis B were enrolled in the infectious diseases center of the first affiliated Hospital of Xinjiang Medical University. At the same time, 20 cases of healthy control group were selected to detect the concentration of cortisol in peripheral blood at 10: 00, 18: 00, 2:00, and the laboratory indexes of liver function, coagulation function, creatinine and so on, and to compare the concentration of cortisol among the three time periods. The correlativity between cortisol and INRTAT TBiLA stoma meld score was analyzed. Results the adrenocortical dysfunction occurred in the group of chronic and acute hepatic failure associated with HBV-related and acute hepatic failure, and in the group of chronic hepatitis B, about 43% of the patients suffered from adrenocortical dysfunction. The concentrations of cortisol in normal group at 2:00 were 93.53 卤54.33 nmol / L and 19.06 卤8.11 nmol / L respectively, which showed a decreasing trend. There was a significant difference among the three groups. There was a positive correlation between the concentration of cortisol in peripheral blood and PTA at 2:00 in the group of HBV associated with HBV and acute liver failure, and with the score of R0.421P0.05 of INRRRRN 0.406P0.05Mel), which was negatively correlated with PTA at 2:00, and was positively correlated with the concentration of cortisol in patients with acute hepatic failure (AHF), and there was a positive correlation between the concentration of cortisol in peripheral blood and PTA, and the score of R0.421P0.05 in the patients with acute liver failure. There was no significant correlation between the concentration of cortisol in peripheral blood at 2:00 in the death group with acute liver failure and the level of cortisol in the patients with acute liver failure at 2:00, which was significantly higher than that in the survival group (122.72 卤83.51 nmol / L), the difference was statistically significant (t 2.33, P 0.05), and the area under the ROC curve was 0.763with statistical significance. Conclusion there are neuroendocrine immune system changes in patients with chronic and acute hepatic failure associated with HBV. The incidence of adrenocortical dysfunction was higher in patients with chronic HBV-associated chronic and acute liver failure at 2:00 in the morning, and was related to the severity of the disease and the prognosis of the patients.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R575.3

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