血清降钙素原和常用炎症指标联合CTP评分对慢加急性肝衰竭短期预后的预测价值  

Short-term prognostic value of serum procalcitonin and common inflammation markers combined with CTP score in patients with acute-on-chronic liver failure

作　　者：傅叁君 高国生[2] 胡爱荣[2] 祝成亮[3] 

机构地区：[1]宁波奉化市疾病预防控制中心,浙江宁波315500 [2]宁波市第二医院,浙江宁波315010 [3]武汉大学人民医院,武汉430060

出　　处：《中国实用内科杂志》2015年第6期519-521,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家973计划(2012CB518900);宁波市科技局社会发展项目(2009C50025);吴阶平医学基金会肝病医学部肝功能评价方法研究基金(LDWMF-PJ-2011A003)

摘　　要：目的探讨血清降钙素原(PCT)、常用炎症指标及CTP评分系统联合应用对慢加急性肝衰竭患者短期(3个月)预后的预测价值。方法收集2013年11月至2014年2月宁波市第二医院收治的72例慢加急性肝衰竭患者,分成生存组和死亡组,记录入院时的CTP评分,并检测患者的常用炎症指标及血清降钙素原(PCT),应用受试者工作特征曲线下面积(AUC)评价血清降钙素原(PCT)、常用炎症指标和CTP评分单项及联合应用对慢加急性肝衰竭患者短期预后的预测价值。结果生存组患者血清降钙素原(PCT)、常用炎症指标(白细胞计数、中性粒细胞百分比及计数、C反应蛋白)及CTP评分均显著低于死亡组(P均<0.05)。ROC曲线结果显示,各指标对慢加急性肝衰竭的预后均有一定的诊断价值(P均<0.05),但除了中性粒细胞百分比及计数、PCT、CTP评分显著优于白细胞计数外,其余指标之间的差异均不大(P均>0.05)。Logistic回归分析结果表明,PCT、中性粒细胞百分比及CTP评分入选模型构建的指标,联合预测因子的ROC曲线下面积达到0.875。结论 PCT可用于慢加急性肝衰竭患者短期临床预后的预测,通过对多指标的联合运用可有效提高预测的准确性。Objective To explore the short-term （3 months） prognostic value of serum procalcitonin （PCT）, common inflammation markers and Child-Turcotte-Pugh （CTP） score alone or combined in patients with acute-on-chronic liver failure. Methods A total of 72 patients with acute-on-chronic liver failure were divided into survival group and dead group. CTP scores of the patients were recorded when hospitalized and serum PCT level was detected. The prognostic values of serum PCT, common inflammation markers and CTP scores alone or combined were assessed using ROC. Results The serum concentration of PCT, the serum levels of common inflammation markers and CTP scores were significantly lower in the survival group than those in the dead group （all P〈 0.05）, and the death rate was elevated with the increasing concentration of serum PCT（P〈 0.001）. We found all the markers above had some prognostic value for patients with acute-on-chronic liver failure through ROC （all P 〈 0.05）. There was no statistical difference among the markers （all P〉 0.05） except that PCT and CTP scores were much better than WBC count. The area under the curve of combined predictors established from serum PCT NEU% and CTP scores by multivariate logistic regression analysis was 0.875. Conclusion Serum procalcitonin can be used to predict the short-term prognosis of patients with acute-on-chronic liver failure, and the accuracy of prediction could be effectively improved by combination of multiple markers.

关 键 词：肝功能衰竭 降钙素原 C反应蛋白 

分 类 号：R575.3[医药卫生—消化系统]