终末期肝衰竭伴急性肾损伤患者血清降钙素原水平研究

Analysis of procalcitonin in patients with end stage liver disease complicated with acute kidney injury

目的 探讨降钙素原检测在终末期肝衰竭患者发生急性肾损伤中的价值.方法 病例对照研究.收集四川大学华西医院2009年1月至2012年1月90例住院患者临床资料,其中终末期肝衰竭伴急性肾损伤患者40例（急性肾损伤组）,终末期肝衰竭且肾功能正常患者50例（对照组）.记录两组患者年龄、性别、肝衰竭病因、Child-pugh分级、终末期肝病模型（model for end-stage liver disease,MELD）评分、感染发生率及类型及全身炎性反应（systemic inflammatory response,SIRS）评分.同时采集两组患者血液,采用罗氏Modular-P800全自动生化分析仪检测肾功能并采用罗氏Cobas E170全自动电化学发光分析仪检测降钙素原水平.比较两组患者的临床资料和检测指标.计数资料采用x2检验;正态分布计量资料采用成组资料的t检验;非正态分布计量资料采用Wilcoxon秩和检验.急性肾衰竭组降钙素原水平与肾功能指标的相关性采用Spearman秩相关分析.结果 急性肾损伤组感染发生率为82.5％,高于对照组的26.0％,差异有统计学意义（x2=26.68,P＜0.05）.急性肾损伤组降钙素原水平和SIRS评分分别为8.72（3.14,31.68） μg/L和2.15±1.11,高于对照组的0.11（0.04,0.45） μg/L和0.67±0.59 （H=81,t =6.36,P＜0.05）.急性肾损伤组降钙素原与尿素显示较好的相关性（r =0.67,P＜0.05）.结论 终末期肝衰竭并发急性肾损伤患者感染率和降钙素原水平增高,提示感染引发的脓毒血症与终末期肝衰竭患者发生急性肾损伤密切相关,降钙素原检测对终末期肝衰竭患者急性肾损伤的发生有提示作用.

Objective To explore the role of procalcitonin （PCT） test in patients with end stage liver disease（ESLD） complicated with acute kidney injury （AKI）.Methods This is a case control study.Between January 2009 and January 2012,40 ESLD inpatients with AKI were enrolled in AKI group while 50 ESLD inpatients with normal renal function were included in control group.Clinical data such as age,gender,etiology of liver failure,infection rates and types,child-pugh classification,model for endstage liver disease（MELD） score and systemic inflammatory response（SIRS） score of the two groups were recorded.Serum renal function were tested via Roche Modular-P800 automatic biochemical analyzer and PCT were tested via Roche E170 automatic electrochemical luminescence analyzer.Count data were analyzed by chi-square test,normal distribution measurement data were analyzed by student t test and non-normal distribution measurement data were analyzed by Wilcoxon rank sum test.Spearman correlation analysis between PCT and renal function was performed in AKI group.Results Infection rates of AKI group （82.5 ％） was significantly（x2 =25.68,P ＜ 0.05） higher than that of control group （26.0％）.PCT level and SIRS score of AKI group [8.72（3.14,31.68） μg/L and 2.15 ± 1.11] were significantly （H and t values were 6.78 and 6.36 respectively,P ＜ 0.05） higher than those of control group [0.11 （0.04,0.45） μg/L,and 0.67 ± 0.59].In AKI group,PCT and urea performed were well related （r =0.67,P ＜0.05）.Conclusion Elevated infection rate and PCT level in ESLD patients with AKI suggest that infection and consequent sepsis are closely associate with AKI in ESLD patients and elevated PCT level may indicate the high risk of AKI in patients with ESLD.