降钙素原联合凝血因子预测肝硬化并发自发性细菌性腹膜炎预后的研究  

Procalcitonin combined with coagulation factors in prognosis of cirrhotic patients complicated with spontaneous bacterial peritonitis

作　　者：盛棋跃[1] 刘敏慧[1] 陈海君[1] 郭玉香[1] 应华永[2] 汪建明[1] 盛吉芳[3] Sheng Qiyue;Liu Minhui;Chen Haijun;Guo Yuxiang;Ying Huayong;Wang Jianming;Sheng Jifang(Department of lnfectious Diseases;Clinical Laboratory;Jinhua Central Hospital,Jinhua 321000,Zhejiang Province,China;Department of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江省金华市中心医院感染科,321000 [2]浙江省金华市中心医院检验科,321000 [3]浙江大学医学院附属第一医院感染科,杭州310003

出　　处：《中华临床感染病杂志》2018年第5期353-358,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金委员会资助项目（816705671008892）;金华市科技局社会发展重点项目（2015-3-007）

摘　　要：目的 探究降钙素原（PCT）联合凝血因子在评价肝硬化并发自发性细菌性腹膜炎（SBP）短期预后中的价值.方法 回顾性分析2014年6月至2017年10月金华市中心医院感染科128例肝硬化并发SBP住院患者临床资料.根据患者3个月生存情况,将其分为存活组（n=83）和死亡组（n=45）,采用多因素Logistic回归分析影响肝硬化并发SBP的预后因素,计算回归系数作为权重,建立预测指数模型.计算受试者工作曲线下面积（AUC）,评价PCT联合凝血因子预测肝硬化并发SBP预后的准确性.结果 单因素分析显示,基线PCT、总胆红素（TBil）、血肌酐（Scr）、凝血酶原时间（PT）、凝血酶原活动度（PTA）及凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅸ、Ⅹ、Ⅺ、Ⅻ水平是影响肝硬化并发SBP患者预后的相关因素（P〈0.01）.多因素Logistic回归分析显示,PCT、凝血因子Ⅴ和Ⅸ均能独立预测肝硬化并发SBP患者短期预后,其模型为Logit（P）=1.200＋0.099×PCT-0.026×凝血因子Ⅴ-0.038×凝血因子Ⅸ,模型的敏感度为0.822,特异度为0.675,AUC为0.829.与经典MELD评分比较,差异无统计学意义（P〉0.05）.结论 基于PCT与凝血因子Ⅴ、Ⅸ的预测指数模型能较好的预测肝硬化并发SBP患者的短期生存率,其总体预后的评估能力与MELD评分相仿,但模型简单,计算简便,临床较易掌握.Objective To examine the short-term prognostic value of procalcitonin （ PCT ） combined with coagulation factors for cirrhotic patients complicated with spontaneous bacterial peritonitis （SBP）.Methods Clinical data of 128 cirrhotic patients complicated with SBP admitted in Jinhua Central Hospital from June 2014 to October 2017 were retrospectively analyzed .In 3 months after admission , 83 patients survived （ survival group ） and 45 patients died （ fatal group ） .The factors related to prognosis were analyzed with Logistic regression and the prediction model was constructed with the weights derived from regression coefficients.The ROC curve and the area under the curve （AUC） of combination of PCT with coagulation factors were used to predict the survival of patients .Results Univariate analysis indicated that the level of PCT , total bilirubin （ TBil ） , serum creatinine （ Scr ） , prothrombin time （ PT ） , prothrombin activity （ PTA ） , blood coagulation factor Ⅱ, Ⅴ, Ⅶ, Ⅸ, Ⅹ, Ⅺ and Ⅻ were factors affecting the prognosis of cirrhotic patients complicated with SBP （P〈0.01）.Multivariate analysis showed that PCT , blood coagulation factors Ⅴ and Ⅸ were independent factors of short-term prognosis of cirrhotic patients complicated with SBP.The constructed predictive model was Logit （P） =1.200＋0.099 ×PCT-0.026 × clotting factor Ⅴ-0.038 ×clotting factor Ⅸ.The sensitivity and specificity of the model were 0.822 and 0.675, respectively, and the AUC was 0.829.Compared with the classic MELD score , the difference was not statistically significant （P〉0.05）.Conclusions The predictive model based on PCT and coagulation factors Ⅴand Ⅸcan effectively predict the short-term survival of cirrhotic patients complicated with SBP . The overall prognostic ability is not different from MELD score , but the model is more simple and easier to apply.

关 键 词：因子V 因子IX 降钙素原 肝硬化 自发性细菌性腹膜炎 预后 

分 类 号：R575.2[医药卫生—消化系统]