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目的探讨血清降钙素原(PCT)和修正全身炎症反应综合征(ASS)评分单独和联合应用对慢加急性肝衰竭患者短期(3个月)预后的预测价值。方法 72例慢加急性肝衰竭患者分成生存组和死亡组,记录入院时的ASS评分,并检测血清PCT,应用受试者工作特征曲线(ROC)下面积评价PCT、ASS评分单项及联合应用对疾病预后的预测价值。结果生存组患者PCT浓度、ASS评分分别为0.47 ng/ml±0.36 ng/ml、(5.25±2.72)分,而死亡组分别为1.31 ng/ml±1.27 ng/ml、(7.90±3.04)分,差异均有统计学意义(P<0.01);死亡率随PCT浓度和ASS评分的增加而升高(P<0.01)。PCT、ASS评分的ROC曲线下面积分别为0.775(0.661~0.865)、0.808(0.698~0.918),差异无统计学意义(P>0.05)。对PCT、ASS评分等进行多因素Logistic回归分析,联合预测因子的ROC曲线下面积达到0.870。结论血清降钙素原和ASS评分均可用于慢加急性肝衰竭患者短期临床预后的预测,两者的联合运用可有效提高预测的准确性。
Objective To investigate the predictive value of serum procalcitonin (PCT) and modified systemic inflammatory response syndrome (ASS) score in the short term (3 months) prognosis of patients with acute and chronic liver failure. Methods Seventy-two patients with acute and chronic liver failure were divided into survival group and death group. The ASS score at admission, serum PCT, and area under receiver operating characteristic curve (ROC) were used to evaluate the PCT, ASS score and combined application Prognostic value of disease prognosis. Results In the survival group, the PCT concentrations and ASS scores were 0.47 ng / ml ± 0.36 ng / ml and 5.25 ± 2.72, respectively, while those in the death group were 1.31 ng / ml ± 1.27 ng / ml and 7.90 ± 3.04, The difference was statistically significant (P <0.01). The mortality rate increased with the increase of PCT concentration and ASS score (P <0.01). The area under the ROC curve of PCT and ASS scores were 0.775 (0.661-0.865) and 0.808 (0.698-0.918 respectively), with no significant difference (P> 0.05). Multivariate Logistic regression analysis on PCT and ASS scores showed that the area under the ROC curve of the combined predictors reached 0.870. Conclusions Both serum procalcitonin and ASS scores can be used to predict short-term clinical prognosis in patients with acute and chronic liver failure. The combination of the two can effectively improve the accuracy of the prediction.