全身炎症反应综合征对肝硬化患者的肝肾功能以及临床结局的影响

Impact of hepatorenal function and clinical outcomes in patients with liver cirrhosis combined with systemic inflammatory response syndrome

目的研究肝硬化患者合并全身炎症反应综合征(SIRS)的发生率以及SIRS对肝肾功能和临床结局的影响。方法选择我院收治的肝硬化患者203例作为研究对象,对其在住院期间的临床表现、实验室指标以及临床评分进行随访记录,并以患者死亡和出现门静脉高压并发症作为随访终点。结果 81例患者合并SIRS。合并SIRS组黄疸发病率、细菌感染率、白细胞计数升高、血红蛋白降低、血清肌酐升高、丙氨酸转氨酶升高、血清胆红素升高、国际标准化比值(INR)、心率、血清白蛋白降低和Child-Pugh评分升高密切相关,差异均具有统计学意义(均P<0.05)。合并SIRS组病死率、门静脉高压出血发生率、肝性脑病发生率以及1型肝肾综合征(HRS-1)均显著高于未合并SIRS组患者(均P<0.01)。死亡患者SIRS发病率显著高于存活患者(P<0.01)。门静脉高压并发症患者SIRS发病率显著高于无门静脉高压并发症的患者(P<0.01)。SIRS和Child-Pugh分级评分是患者死亡(SIRS:OR=0.505,P<0.01;Child-Pugh分级:OR=0.412;P<0.01)和门静脉高压并发症(SIRS:OR=0.494,P<0.01;Child-Pugh分级:OR=0.309;P<0.01)的独立影响因素。结论 SIRS好发于中晚期肝硬化患者,且与门静脉高压并发症密切相关,合并SIRS的患者其病死率显著增高。

Objective To assess the prevalence of the systemic inflammatory response syndrome（SIRS） and to study the impact of hepatorenal function and clinical outcomes in patients with liver cirrhosis combined with systemic inflammatory response syndrome. Methods Two hundred and three patients with liver cirrhosis were examined and investigated with close monitoring during hospital stay. The clinical manifestations, laboratory parameters and clinical scores were also followed up. The main clinical endpoints were death and the development of portal hypertension-related complications. Results Eighty-one patients met the criteria of SIRS. We found significant correlations between SIRS and jaundice,bacterial infection, white blood cell count, low haemoglobin concentration, high serum creatinine levels, high alanine aminotransferase levels, serum bilirubin levels, international normalised ratio, serum albumin levels, high Child-Pugh score （all P G 0.05）. The mortality, incidence of portal hypertension bleeding, incidence of hepatic encephalopathy,and type 1 hepatorenal syndrome（HRS-1） of SIRS patients were significantly higher than those of patients without SIRS （all P 〈 0.01）. The incidence of SIRS in death patients was significantly higher than that of surviving patients （P G 0.01 ）. The incidence of SIRS in patients with portal hypertension complications was significantly higher than that in patients without portal hypertension complications （ P 〈0.01）. SIRS and Child-Pugh score were indeISendent factors of death （SIRS： OR = 0. 505, P G 0.01 ; Child-Pugh; OR = 0. 412 ; P 〈 0.01 ） and portal hypertension complications （SIRS： OR = 0. 494, P 〈0.01 ;Child-Pugh： OR = 0. 3093 P G0.01）. Conclusion SIRS occurs in patients with advanced cirrhosis and is associated with portal hypertension-related complications. The mortality of patients with SIRS increases significantly.