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目的探讨血清降钙素原(procalcitonin,PCT)和内毒素等常用炎症因子指标结合终末期肝病模型(model for endstage liver disease,MELD)对慢性重症肝炎预后的预测价值。方法选取2011年1月—2013年12月慢性重症肝炎87例,入院24 h内检测PCT、内毒素、WBC计数、中性粒细胞(polymorphonuclear,PMN)计数和C-反应蛋白(C-reactin protein,CRP),同时进行MELD评分,并根据随访情况分为生存组和死亡组。结果单因素分析显示生存组PCT、CRP、MELD评分、WBC和PMN计数等显著低于死亡组,差异有统计学意义(P<0.05),内毒素检测结果比较2组差异无统计学意义(P=0.620)。Logistic回归分析显示MELD评分、CRP、PCT和慢性重症肝炎死亡相关(P<0.05);CRP和MELD评分呈正相关,Spearman相关系数为0.69(P<0.05);PCT和MELD评分呈正相关,Spearman相关系数为0.72(P<0.05)。结论 PCT和CRP纳入预测体系有可能提高重症肝炎预后的预测价值。
Objective To investigate the predictive value of serum procalcitonin (PCT), endotoxin and other commonly used inflammatory cytokines combined with model for end stage liver disease (MELD) in predicting the prognosis of chronic severe hepatitis. Methods 87 patients with chronic severe hepatitis from January 2011 to December 2013 were enrolled in this study. PCT, endotoxin, WBC count, polymorphonuclear (PMN) count and C-reactin protein , CRP), MELD score at the same time, and according to follow-up were divided into survival group and death group. Results The univariate analysis showed that the PCT, CRP, MELD score, WBC and PMN count in survival group were significantly lower than those in death group (P <0.05). There was no significant difference in endotoxin test between the two groups (P = 0.620). The Logistic regression analysis showed that there was a significant correlation between MELD score, CRP, PCT and the death of chronic severe hepatitis (P <0.05). The CRP and MELD scores were positively correlated with the Spearman correlation coefficient of 0.69 (P <0.05). The Spearman correlation coefficient 0.72 (P <0.05). Conclusions The inclusion of PCT and CRP in the prediction system may improve the predictive value of severe hepatitis prognosis.