本文選題：乙肝　切入點：慢加急性肝衰竭　出處：《廣東醫(yī)學》2017年21期

【摘要】：目的分析乙肝相關性慢加急性肝衰竭(HBV-ACLF)患者治療前后降鈣素原(PCT)水平的差值(ΔPCT)與病情轉歸的相關性。方法觀察組為90例HBV-ACLF患者,空白對照組為30例乙肝肝硬化代償期患者。觀察組檢測治療前(基線水平)、治療后的肝臟生化、凝血功能及PCT并計算MELD評分,將治療2周時MELD評分下降≥3分患者記為好轉,下降3分記為無好轉。空白對照組只檢查上述指標1次作為基線水平的評估。分析觀察組患者治療前后PCT水平的變化及其差值(ΔPCT)與MELD評分、總膽紅素、國際標準化比值、血肌酐的相關性。對觀察組患者90 d死亡率作預測分析,比較PCT、ΔPCT、MELD評分及其聯(lián)合應用的曲線下面積(AUC),評估上述指標的預測價值。結果早期HBV-ACLF治療好轉組PCT的基線水平較治療無好轉組高[(1.08±0.82)mg/L vs(0.65±0.36)mg/L,P=0.007],且治療好轉組于2周時測PCT較基線水平明顯下降,而治療無好轉組反而升高,ΔPCT分別為(-0.48±0.66)mg/L及(0.2±0.56)mg/L,組間比較差異有統(tǒng)計學意義(P0.001)。而中期HBV-ACLF患者治療好轉組及治療無好轉組的PCT基線水平無明顯差異[(0.6±0.32)vs.(0.58±0.31)mg/L,P=0.980],兩組患者治療前后的PCT變化不明顯,ΔPCT分別為(-0.07±0.37)mg/L及(0.01±0.39)mg/L,組間比較差異無統(tǒng)計學意義(P=0.959)。觀察組HBV-ACLF患者治療前后的ΔPCT與ΔMELD分值、ΔTB呈中度相關(相關系數(shù)分別為0.430及0.528,P均0.001),但與ΔCr及ΔINR無相關性。以受試者工作特征曲線(ROC)對觀察組患者入院90 d死亡率作預測分析表明:在早期HBV-ACLF患者中,以ΔPCT聯(lián)合MELD的AUC較單獨使用MELD評分的要高,分別為0.80和0.69,P=0.054,處于臨界值。結論早期HBV-ACLF患者的PCT水平高者短期(2周)療效好,其ΔPCT水平與其病情轉歸相關,以ΔPCT水平聯(lián)合MELD評分對于患者的90 d死亡率有預測價值。
[Abstract]:Objective to analyze the correlation between the difference (螖 PCT) and the prognosis of patients with chronic hepatitis B associated with acute hepatic failure (HBV-ACLF) before and after treatment. Methods 90 patients with HBV-ACLF were enrolled in the study group. In the control group, the liver biochemistry, coagulation function and PCT were measured before and after treatment, and the MELD scores were calculated. The patients whose MELD score decreased more than 3 points at 2 weeks after treatment were recorded as improved. The decrease of 3 points was recorded as no improvement. The blank control group only checked the above indexes once as the baseline level evaluation. The changes of PCT level and its difference (螖 PCT) and MELD score, total bilirubin, international standardized ratio before and after treatment in the observation group were analyzed. Correlation of serum creatinine. The 90 day mortality of patients in the observation group was predicted and analyzed. Compared with the score of PCT, 螖 PCT meld and the area under the curve used in combination, we evaluated the predictive value of the above indexes. Results the baseline level of PCT in the early HBV-ACLF group was higher than that in the non-improvement group [1.08 鹵0.82)mg/L vs(0.65 鹵0.36 mg / L P0. 007], and PCT was measured in the improved group at 2 weeks. The line level has dropped significantly, The 螖 PCT was -0.48 鹵0.48 鹵0.66)mg/L and 0.2 鹵0.56 mg / L, respectively, and the difference between the two groups was statistically significant (P 0.001), but there was no significant difference in the baseline level of PCT between the two groups before and after treatment [0.6 鹵0.32)vs.(0.58 鹵0.31 mg / L P 0.980]. There was no significant change in PCT, 螖 PCT was -0.07 鹵0.37)mg/L and 0.01 鹵0.39 mg / L, respectively. There was no significant difference between the two groups. The 螖 PCT and 螖 MELD scores of HBV-ACLF patients in the observation group before and after treatment were moderately correlated (correlation coefficients were 0.430 and 0.528, P 0.001, respectively), but there was no correlation with 螖 Cr and 螖 INR. Using the operating characteristic curve of subjects, the mortality of 90 days after admission in the observation group was predicted. The results showed that in the early stage of HBV-ACLF, the mortality rate of the patients in the observation group was higher than that in the control group. The AUC with 螖 PCT combined with MELD was significantly higher than that with MELD score (0.80 and 0.69 P0.054, respectively). Conclusion the high PCT level in early HBV-ACLF patients had a good curative effect for 2 weeks. The 螖 PCT level was correlated with the outcome of the disease. 螖 PCT level combined with MELD score can predict 90 day mortality.
【作者單位】： 廣東醫(yī)學院附屬深圳市第三人民醫(yī)院肝病科;
【分類號】：R512.62;R575.3

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本文編號：1690034