常用炎症因子指标结合终末期肝病模型评分对慢性重症肝炎预后预测价值

Prognostic value of common inflammatory markers combining MELD score for chronic severe hepatitis prognosis

目的探讨血清降钙素原(procalcitonin,PCT)和内毒素等常用炎症因子指标结合终末期肝病模型(model for endstage liver disease,MELD)对慢性重症肝炎预后的预测价值。方法选取2011年1月—2013年12月慢性重症肝炎87例,入院24 h内检测PCT、内毒素、WBC计数、中性粒细胞(polymorphonuclear,PMN)计数和C-反应蛋白(C-reactin protein,CRP),同时进行MELD评分,并根据随访情况分为生存组和死亡组。结果单因素分析显示生存组PCT、CRP、MELD评分、WBC和PMN计数等显著低于死亡组,差异有统计学意义(P<0.05),内毒素检测结果比较2组差异无统计学意义(P=0.620)。Logistic回归分析显示MELD评分、CRP、PCT和慢性重症肝炎死亡相关(P<0.05);CRP和MELD评分呈正相关,Spearman相关系数为0.69(P<0.05);PCT和MELD评分呈正相关,Spearman相关系数为0.72(P<0.05)。结论 PCT和CRP纳入预测体系有可能提高重症肝炎预后的预测价值。

Objective To evaluate the prognostic value of procalcitonin（PCT）and common inflammatory markers combining the model for end-stage liver disease（MELD） score in patients with chronic severe hepatitis（CSH）. Methods A total of 87 patients with CSH were collected from Jan. 2011 to Dec. 2013. Indexes of PCT, endotoxins, WBC, PMN, C-reactin protein（CRP） and MELD were determined within 24 h after the admission. According to the outcome, the 87 patients were divided into a survival group（n=51）and a death group（n=36）. Results PCT, CRP, MELD score and PMN in survival group by single factor analysis were significantly lower than those in the death group（P〈0.05）. Binary logistic regression analysis indicated that MELD score, CRP and PCT highly correlated with the death of CSH. CRP was positively correlated with MELD score and Spearman＇s correlation coefficient was 0.69（P〈0.05）. PCT was also positively correlated with the MELD, and Spearman＇s correlation coefficient was 0.72（P〈0.05）. Conclusion Compared with the traditional prediction method, serum PCT and CRP can improve the ability to predict the prognosis for CSH.