PCT和CRP及外周血WBC水平对预测肝硬化并发感染性休克的临床价值

Clinical Significance of Serum Procalcitonin, C-reactive Protein and Peripheral Blood Leukocyte Levels in Predicting Cirrhosis Complicated with Septic Shock

目的:分析血清降钙素原(PCT)、C反应蛋白(CRP)水平和外周血白细胞计数(WBC)对预测肝硬化并发感染性休克的临床价值。方法:收集失代偿期肝硬化未发生感染性休克患者(对照组,50例)和并发感染性休克患者(研究组,50例)入院时血液总胆红素(TBIL)、白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)及肌酐(Cr)等资料,于入院当日(治疗前)检测所有患者和研究组患者治疗后第1天、第3天和第7天采集血液标本,采用全自动免疫荧光分析仪检测血清PCT、特定蛋白分析仪通过散射比浊法检测血清CRP、全自动血液分析仪检测外周血WBC,比较对照组和研究组患者3项指标的差异、比较研究组死亡患者和生存患者在治疗后3个时间点时3项指标的差异。结果:2组患者的ALT、AST、GGT和ALP水平差异无统计学意义(P>0.05),研究组患者TBIL和Cr水平高于对照组,ALB水平低于对照组,差异均有统计学意义(P<0.05);研究组患者PCT、CRP和WBC水平均高于对照组,差异有统计学意义(P<0.05);研究组生存患者治疗后第1天、第3天和第7天时的血液PCT、CRP和WBC水平都低于死亡组,差异有统计学意义(P<0.05或P<0.01),生存组患者治疗后PCT、CRP和WBC水平均随着治疗时间延长而逐渐降低(P<0.05);PCT的ROC曲线下面积为0.786(95%CI:0.695~0.876,P<0.001),CRP的ROC曲线下面积为0.770(95%CI:0.677~0.863,P<0.001),WBC的ROC曲线下面积为0.656(95%CI:0.544~0.768,P=0.008)。结论:PCT、CRP水平及WBC计数可作为预测肝硬化患者发生感染性休克及严重程度的血液学指标。

Objective:To analyze the clinical value of serum procalcitonin(PCT),C-reactive protein(CRP)and peripheral blood white blood cell(WBC)levels in predicting cirrhosis complicated with septic shock.Methods:A total of 50 decompensated cirrhosis patients complicated without septic shock(the study group)and 50 patients with septic shock(the control group)were enrolled.The information of participants were collected,including gender,age,total bilirubin(TBIL),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),creatinine(Cr)at admission.The serum level of PCT was detected by a fully automated immunofluorescence analyzer,the serum level of CRP was detected by a nephelometric method using a specific protein analyzer,and the peripheral blood WBC was detected by a fully automatic blood analyzer.The levels of PCT,CRP,and WBC were measured on the 1st,3rd,and 7th days after treatment in the study group,and on the day of admission(before treatment)in all participants,and statistical analysis was performed.Results:There was no significant difference in ALT,AST,GGT and ALP levels between the two groups(P>0.05).The TBIL and Cr levels in the study group were higher than those in the control group,while the ALB levels were lower than those in the control group,and the difference was statistically significant.(P<0.05).The PCT,CRP and WBC levels in the study group were higher than those in the control group,and the difference was statistically significant(P<0.05).After treatment,38 cases in the study group were survival and 12 of them died.Before treatment,there was no significant difference in the levels of PCT,CRP and WBC between the survival group and the death group(P>0.05).Compared with before treatment,the PCT,CRP and WBC levels in the survival group gradually decreased with the time of treatment,and the difference was statistically significant(P<0.05);In the death group,the PCT,CRP and WBC levels 1 day after treatment decreased compared with before treatment,the levels 3 days after treatment were higher than those 1 day after treatment,and the level 7 days after treatment was higher than that 3 days after treatment,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the area under the curve of PCT was 0.786(95%CI:0.695~0.876,P=0.000),the area under the curve of CRP was 0.770(95%CI:0.677~0.863,P=0.000),and the area under the curve of WBC was 0.656(95%CI:0.544~0.768,P=0.008).Conclusion:PCT,CRP and WBC may have important reference value in predicting the possibility and severity of septic shock in patients with cirrhosis.