肝衰竭患者血清降钙素原测定的应用价值

摘要

Objective To explore the value of serum procalcitonin in patients with hepatic failure.Methods Totally 106 patients with hepatic failure from January 2009 to October 2014 were enrolled and divided into infection group (75 cases) and non-infection group (31 cases).After anti-infection treatment,75 cases in infection group weredivided into high procalcitonin group (33 cases) and low procalcitonin (42 cases) according to the level of serum procalcitonin.Twenty three cases of liver failure patients with calcitonin peptide ＜ 0.5 μg/L underwent serum procalcitonin reexamination within 48 h and divided into procalcitonin increasing ＞ 1 time group (10 cases) and procalcitonin increasing ＜ 1 time group (13 cases).The value of procalcitonin for early diagnosis and prognosis prediction of bacterial infections were evaluated.Results In infection group,there were 72 cases with procalcitonin≥0.5 μg/L [96.0％ (72/75)],significantly more than that in non-infection group [35.5％ (11/31)] (x2 =47.28,P ＜ 0.01).In high procalcitonin group,21 cases were dead [63.6％ (21/33)],significantly more than that in low procalcitonin group[14.3％ (6/42)] (x2 =19.53,P ＜ 0.01).There were 6 cases in procalcitonin increasing ＞ 1 time group and 2 cases in procalcitonin increasing ＜ 1 time group were complicated with infection with significantly differece (P ＜ 0.05).Conclusion Serum procalcitonin is important for early diagnosis and prediction of infection in hepatic failure patients;it is also important for prediction of hepatic failure complicated with infection.%目的 探讨血清降钙素原测定在肝衰竭患者中的应用价值.方法 回顾性分析2009年1月至2014年10月在平煤神马医疗集团总医院住院治疗的由病毒性肝炎导致的肝衰竭患者106例,测定细菌感染情况.依据是否发生感染把106例患者分为感染组(75例)和非感染组(31例).将合并细菌感染的75例肝衰竭患者按抗感染治疗后降钙素原的变化分为降钙素原上升组(33例)和降钙素原下降组(42例).对降钙素原＜0.5 μg/L的23例肝衰竭患者,48 h内再次复查,按照48 h内降钙素原上升情况分为降钙素原上升＞1倍组(10例)和降钙素原上升＜1倍组(13例).分析血清降钙素原浓度测定对肝衰竭合并细菌感染早期诊断和抗感染治疗后预后判断的价值,以及连续监测降钙素原对肝衰竭患者发生细菌感染的预测价值.结果 感染组75例患者中降钙素原≥0.5 μg/L者为72例(96.0％),非感染组31例患者中降钙素原≥0.5μg/L者为11例(35.5％),2组比较差异有统计学意义(x2=47.28,P＜0.01);降钙素原上升组33例中死亡21例(63.6％),降钙素原下降组42例中死亡6例(14.3％),2组病死率比较差异有统计学意义(x2=19.53,P＜0.01);降钙素原上升＞1倍组10例中合并细菌感染6例;降钙素原上升＜1倍组13例中合并细菌感染2例,Fisher精确检验显示2组间差异有统计学意义(P＜0.05).结论 测定血清降钙素原水平对肝衰竭合并细菌感染的早期诊断、预后及肝衰竭患者发生细菌感染的预测具有重要意义.