成人肝硬化感染性休克患者血氨水平变化分析  

Analysis of changes of blood ammonia level in adult patients with liver cirrhosis and septic shock

作　　者：胡建良 张思泉 赵曦 ZHANG Siquan;ZHAO Xi(Department of Intensive Care Medicine,Affiliated Hangzhou Xixi Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属杭州市西溪医院重症医学科,浙江杭州310000

出　　处：《全科医学临床与教育》2024年第6期501-505,共5页Clinical Education of General Practice

摘　　要：目的探讨成人肝硬化感染性休克患者血氨水平变化情况。方法选择90例肝硬化感染性休克患者为观察组,同期59例非肝硬化感染性休克患者为对照组,比较两组治疗前后及不同生存预后患者的血氨、血清降钙素原(PCT)、白细胞介素-6(IL-6)以及C反应蛋白(CRP)水平;比较观察组不同肝功能分级患者血氨、PCT、IL-6以及CRP水平;应用受试者工作特征(ROC)曲线评价血氨、PCT、IL-6以及CRP对肝硬化患者感染性休克预后的预测价值;分析观察组治疗前血氨与PCT、IL-6、CRP及肝功能分级的相关性。结果治疗后观察组患者血氨、PCT、IL-6以及CRP均高于对照组(t分别=3.77、2.65、3.33、3.71,P均<0.05);观察组存活患者血氨、PCT、IL-6以及CRP水平均明显低于死亡患者,差异均有统计学意义(t分别=3.23、2.61、2.54、2.43,P均<0.05);两组存活患者中,观察组患者治疗前血氨、PCT、IL-6以及CRP水平相较于对照组更高(t分别=5.33、6.39、5.67、6.87,P均<0.05);观察组患者Child分级中A级患者血氨、PCT、IL-6以及CRP水平均明显低于B级患者(t分别=4.13、2.21、2.08、2.21,P均<0.05),B级患者明显低于C级患者(t分别=2.98、2.08、2.46、2.69,P均<0.05)。治疗前血氨预测肝硬化感染性休克预后截点值为37.71μmol/L,曲线下面积(AUC)为0.82,灵敏度和特异度分别为66.67%、90.12%;血清PCT截点值为30.97 ng/mL,AUC为0.76,灵敏度和特异度分别为77.78%、67.90%;血清IL-6截点值为77.70 ng/mL,AUC为0.69,灵敏度和特异度分别为88.89%、55.56%;血清CRP截点值为64.23 mg/L,AUC为0.78,灵敏度和特异度分别为88.89%、54.32%;观察组治疗前PCT、IL-6以及CRP水平、Child分级与血氨水平呈正相关(r分别=0.67、0.88、0.57、0.55,P均<0.05)。结论血氨水平与肝硬化感染性休克患者病情发展密切相关,其对肝硬化感染性休克患者早期临床诊断价值较高,且血氨水平与PCT、IL-6、CRP水平、Child分级呈正相关。Objective To explore the changes of blood ammonia level in adult patients with liver cirrhosis complicated with septic shock.Methods A total of 90 patients with liver cirrhosis and septic shock were enrolled as observation group,and 59 patients with septic shock without liver cirrhosis were included in control group.The levels of blood ammonia,PCT,IL-6 and CRP were compared between two groups before and after treatment and among the patients with different survival prognosis status.The levels of blood ammonia,PCT,IL-6 and CRP in patients with different liver function grades in observation group were compared.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of blood ammonia,PCT,IL-6 and CRP on prognosis of septic shock in patients with liver cirrhosis.The correlation between blood ammonia and PCT,IL-6,CRP and liver function grading in observation group before treatment was analyzed.Results The levels of blood ammonia,PCT,IL-6 and CRP were higher in observation group(t=3.77,2.65,3.33,3.71,P<0.05).The levels of blood ammonia,PCT,IL-6 and CRP of surviving patients in observation group were significantly lower than those of dead patients(t=3.23,2.61,2.54,2.43,P<0.05).The levels of blood ammonia,PCT,IL-6 and CRP of surviving patients in observation group before treatment were higher than those in control group(t=5.33,6.39,5.67,6.87,P<0.05).In observation group,the levels of blood ammonia,PCT,IL-6 and CRP in Child grade A patients were significantly lower than those in grade B patients(t=4.13,2.21,2.08,2.21,P<0.05),and the above levels were lower in grade B patients than those in grade C patients(t=2.98,2.08,2.46,2.69,P<0.05).The cut-off value,area under the curve(AUC),sensitivity and specificity of blood ammonia were 37.71μmol/L,0.82,66.67% and 90.12%.The cut-off value,AUC,sensitivity and specificity of PCT were 30.97 ng/mL,0.76,77.78% and 67.90%.The cut-off value,AUC,sensitivity and specificity of IL-6 were 77.70 ng/mL,0.69,88.89% and 55.56%.The cut-off value,AUC,sensitivity and s

关 键 词：非肝硬化 肝硬化 感染性休克 血氨水平 

分 类 号：R575.2[医药卫生—消化系统]