炎症因子动态变化在失代偿期肝硬化合并脓毒血症中的临床意义

Clinical significance of dynamic changes of inflammatory factors in decompensated cirrhosis combined with sepsis

目的探讨血清降钙素原(procalcitonin,PCT)、超敏C反应蛋白(High-sensitivity C-reactive protein,Hs-CRP)和白细胞介素-6(interleukin-6,IL-6)的动态变化对失代偿期肝硬化合并脓毒血症患者预后的预测评估价值。方法回顾性分析2015年1月至2018年12月住院就诊于新疆医科大学第一附属医院感染性疾病中心诊断为失代偿期肝硬化合并脓毒血症的患者62例,根据患者28天的预后分为存活组27例和死亡组35例,所有患者分别于入院后第1、3、5、7 d采用化学发光法、免疫比浊法检测血清PCT、Hs-CRP、IL-6水平,同时对患者进行急性生理学和慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评估。对存活组和死亡组患者各项指标进行差异性分析,评估炎症因子水平的动态变化对失代偿期肝硬化合并脓毒血症患者预后的预测和判断价值。结果存活组与死亡组相比,存活组第1、3 d PCT[(78.64±34.13)和(65.72±22.45)]、Hs-CRP[(957.82±454.21)和(766.68±405.89)]和IL-6[(878.56±257.96)和(759.21±314.70)],与死亡组PCT[(89.12±44.563)和(70.32±40.87)]、Hs-CRP[(922.57±366.21)和(834.13±565.04)]和IL-6[(980.77±354.43)和(860.09±400.78)]比较Hs-CRP[(309.67±210.30)和(119.74±80.34)]和IL-6[(470.33±109.55)差异无统计学差异,第5和7天PCT[(31.19±9.05)和(9.12±3.65)]、(90.75±67.25)],与死亡组PCT[(53.17±25.44)和(40.57±12.33)]、Hs-CRP[(709.29±514.07)和(667.21±415.29)]和IL-6[(809.76±407.31)和(734.06±508.72)]比较差异有统计学显著差异,存活组显著低于死亡组。结论PCT、Hs-CRP、IL-6的动态检测可用于预测失代偿期肝硬化合并脓毒症患者的预后,治疗过程中PCT、Hs-CRP、IL-6水平持续下降,提示预后较好。

Objective To explore the predictive value of serum procalcitonin(PCT),high-sensitivity C-reactive protein(Hs-CRP)and interleukin-6(IL-6)on the prognosis of decompensated cirrhosis patients with sepsis.Methods 62 patients with decompensated cirrhosis complicated with sepsis who were hospitalized in the infectious diseases center of the first affiliated hospital of Xinjiang Medical University from January 2015 to December 2018 were analyzed retrospectively.According to the prognosis of 28 days,the patients were divided into survival group(27 cases)and death group(35 cases).All patients were tested for PCT and Hs-CRP by chemiluminescence and immunoturbidimetry on the 1st,3rd,5th and 7th day after admission,respectively.At the same time,the patients were assessed with Acute Physiology and Chronic Health Evaluation II(APACHE II).Various indexes of survival group and death group were analyzed to evaluate the dynamic changes of inflammatory factors in order to predict and judge the prognosis of decompensated cirrhosis patients combined with sepsis.Results The survival group was compared with the death group.There was no significant difference in PCT、Hs-CRP and IL-6 between survival group and death group.In the survival group,PCT was(78.64±34.13)at the first day and was(65.72±22.45)at the third day.And Hs-CRP was(957.82±454.21)at the first day and was(766.68±405.89)at the third day.And IL-6 was(878.56±257.96)at the first day and was(759.21±314.70)at the third day.In the death group,PCT was(89.12±44.563)and(70.32±40.87)respectively at the first day and at the third day,and Hs-CRP was(922.57±366.21)and(834.13±565.04)respectively at the first day and the third day,and IL-6 was(980.77±354.43)and(860.09±400.78)respectively at day 1 and day 3 after admission.PCT,Hs-CRP,IL-6 at the 5th and 7th day in the survival group were significantly different from those in the death group.PCT were(53.17±25.44)and(40.57±12.33)],Hs-CRP were(709.29±514.07)and(667.21±415.29)],IL-6 were(809.76±407.31)and(734.06±508.72)in the death group.PCT were(31.19±9.05)and(9.12±3.65)]、Hs-CRP were(309.67±210.30)and(119.74±80.34)],IL-6 were(470.33±109.55)and(90.75±67.25)at the the 5th and 7th day in the survival group,whose data were significantly lower than those in the death group.P Conclusions The dynamic detection of PCT,Hs-CRP and IL-6 can be used to predict the prognosis of decompensated cirrhosis patients with sepsis.The levels of PCT,Hs-CRP and IL-6 decreased continuously during the treatment,which shows a better prognosis.