血皮质醇水平对肝衰竭患者诊断90天预后的评估价值  

Prognosis evaluation of serum cortisol level on ninety days in patients with liver failure

作　　者：张剑 陈煜 丁美 段钟平 Zhang Jian;Chen Yu;Ding Mei;Duan Zhongping(Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院疑难肝病及人工肝中心,肝衰竭与人工肝治疗研究北京市重点实验室,100069

出　　处：《北京医学》2021年第11期1090-1093,共4页Beijing Medical Journal

摘　　要：目的探讨血皮质醇(cortisol,COR)水平对肝衰竭患者诊断90 d预后的评估价值。方法选取2018年9月至2020年1月首都医科大学附属北京佑安医院收治的肝衰竭患者211例,根据患者诊断90 d是否存活分为生存组和死亡组,分析两组患者影响预后的因素,血COR对患者诊断90 d预后的评估价值。结果肝衰竭患者211例,其中相对性肾上腺皮质功能不全(relative adrenal insufficiency,RAI)89例(42.2%)。诊断90 d时,生存组143例,死亡组68例。死亡组患者年龄[(48.86±8.60)岁比(41.10±13.36)岁]、男性占比(88.2%比82.5%)、T-BIL[(511.32±151.98)μmol/L比(278.48±148.13)μmol/L]、INR[(4.51±1.62)比(2.34±0.70)]、SCr[(135.64±42.53)μmol/L比(66.61±22.56)μmol/L]、MELD评分[(35.76±4.05)分比(26.99±4.53)分]、RAI比例(80.9%比23.8%)显著高于生存组,而血COR[(192.71±67.23)nmol/L比(339.26±121.19)nmol/L]显著低于生存组,差异均有统计学意义(P<0.05)。多因素logistic回归显示,年龄[OR(95%CI):1.142(1.065~1.225),P<0.001]、MELD评分[OR(95%CI):1.384(1.012~1.895),P=0.032]、T-BIL[OR(95%CI):1.005(1.001~1.010),P=0.005]是影响患者诊断90 d预后的独立危险因素,血COR[OR(95%CI):0.977(0.967~0.988),P<0.001]是独立保护因素。血COR预测90 d生存的ROC曲线的AUC为0.868(95%CI:0.814~0.910,P<0.001),最佳临界值为252.1 nmol/L,敏感性为82.4%,特异性为80.2%,阳性预测值为78.5%,阴性预测值为90.1%。结论血COR对评估肝衰竭患者诊断90 d预后具有一定价值,血COR<252.1 nmol/L提示预后不良。Objective To explore the prognosis value of blood cortisol(COR)level on 90 days in the patients with liver failure.Methods A total of 211 patients with liver failure treated in Beijing Youan Hospital,Capital Medical University from September 2018 to January 2020 were divided into survival group and death group according to 90 days of diagnosis.The factors affecting the prognosis and the diagnosis value of blood COR on 90 days were analyzed.Results Eighty-nine patients(42.2%)complicated with relative adrenocortical insufficiency(RAI)who were diagnosed with liver failure.There were 143 cases in the survival group and 68 cases in the death group at 90 days after diagnosis.The age in the death group[(48.86±8.60)years vs.(41.10±13.36)years],the proportion of men(88.2%vs.82.5%),and T-BIL[(511.32±151.98)μmol/L vs.(278.48±148.13)μmol/L],INR[(4.51±1.62)vs.(2.34±0.70)],SCr[(135.64±42.53)μmol/L vs.(66.61±22.56)μmol/L],MELD score[(35.76±4.05)vs.(26.99±4.53)]and RAI ratio(80.9%vs.23.8%)were significantly higher than those in the survival group,while blood COR[(192.71±67.23)nmol/L vs.(339.26±121.19)nmol/L]was significantly lower than that in the survival group(P<0.05).Multivariate logistic regression showed that age[OR(95%CI):1.142(1.065-1.225),P<0.001],MELD score[OR(95%CI):1.384(1.012-1.895),P=0.032],T-BIL[OR(95%CI):1.005(1.001-1.010),P=0.005]were independent risk factors and blood COR[OR(95%CI):0.977(0.967-0.988),P<0.001]was an independent protective factor.The AUC of ROC curve for predicting 90 days survival by blood COR was 0.868(95%CI:0.814-0.910,P<0.001),cut-off value was 252.1 nmol/L,the sensitivity was 82.4%,the specificity was 80.2%,the positive predictive value was 78.5%,and the negative predictive value was 90.1%.Conclusions Blood COR has a certain value in evaluating the 90 days prognosis in the patients with liver failure.Blood COR<252.1 nmol/L indicates poor prognosis.

关 键 词：肝衰竭 预后 皮质醇 

分 类 号：R575.3[医药卫生—消化系统]