血浆IL-6及降钙素原对肝硬化合并显性肝性脑病抗感染治疗的预后评估价值

Prognosis valuation of plasma IL-6 and procalcitonin in anti-infective treatment of liver cirrhosis and dominant hepatic encephalopathy

目的探讨血浆白细胞介素-6(IL-6)及降钙素原(PCT)对肝硬化合并显性肝性脑病(OHE)抗感染治疗的预后评估价值。方法106例肝硬化合并OHE患者常规治疗15天后密切随访15天,根据预后分为预后良好组41例及预后不良组65例。采集两组患者入院时清晨空腹静脉血检测血氨、血浆钠、肝肾功能标志物、炎性标志物、血常规及凝血功能,计算终末期肝病模型(MELD)评分,比较两组患者临床资料与血检结果的差异性。ROC曲线分析血浆IL-6及PCT对肝硬化合并OHE抗感染治疗效果的诊断效能。结果预后不良组国际标准化值(INR)、血浆IL-6、PCT、MELD评分及部分肝肾功能标志物水平显著高于预后良好组(P<0.05),凝血酶原活动度(PTA)及血小板计数/淋巴细胞计数(PLR)显著低于预后良好组(P<0.05);血浆IL-6、PCT是影响肝硬化合并OHE患者预后的独立危险因素(P<0.05);PLR是影响肝硬化合并OHE患者预后的保护因素(P<0.05)。血浆IL-6、PCT的曲线下面积分别为0.831、0.842;血浆IL-6>65.50 ng/L患者生存率为9.30%,≤65.50 ng/L患者为62.71%;血浆PCT>0.21 ng/L患者生存率为12.13%,≤0.21 ng/L患者为86.67%。结论血浆IL-6及PCT可作为评估肝硬化合并OHE患者抗感染治疗预后的生物学指标。

Aim To explore the prognosis valuation of plasma interleukin-6(IL-6)and procalcitonin(PCT)in anti-infective treatment of liver cirrhosis with overt hepatic encephalopathy(OHE).Methods Totally 106 patients with cirrhosis and OHE were selected in this study,at admission,the clinical data of patients were collected,the fasting blood in the early morning was also collected to detect plasma ammonia,plasma sodium,hepatorenal function markers,inflammatory markers,blood routine and coagulation function,and calculate the end-stage liver disease model(MELD)score.After 15 days of routine treatment and 15 days of close follow up,the patients were divided into good prognosis group(n=41)and poor prognosis group(n=65)based on an outcome scale,and the clinical data and blood test results were compared between the two groups.ROC curve was used to analyze the diagnostic efficacy of IL-6 and PCT in the treatment of cirrhosis with OHE.Results After treatment,the levels of international standardized value(INR),plasma IL-6,PCT,MELD score and some markers of liver and kidney function in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).The levels of prothrombin activity(PTA)and platelet count/lymphocyte count(PLR)in poor prognosis group were significantly lower than those in good prognosis group(P<0.05).Plasma IL-6 and PCT were independent risk factors that affect the prognosis of OHE patients(P<0.05);PLR was a protective factor affecting the prognosis of OHE patients(P<0.05).The area under curve of plasma IL-6 and PCT were 0.831 and 0.842.The survival rate of plasma IL-6>65.50 ng/L was 9.30%,the survival rate of IL-6≤65.50 ng/L was 62.71%;the survival rate of plasma PCT>0.21 ng/L was 12.13%,and the survival rate of PCT≤0.21 ng/L was 86.67%.Conclusion Plasma IL-6 and PCT can be used as biological indicators for the prognosis of patients with liver cirrhosis with overt hepatic encephalopathy.