内毒素血症与肝肾综合征的关系研究

目的分析肝硬化伴I型肝肾综合征患者内毒素血症与肝肾综合征发生的关系.方法纳入肝硬化伴1型肝肾综合征患者38例和肝硬化肾功能正常患者50例,分析肝硬化病因、降钙素原、Child-Pugh分级、终末期肝功能评分、全身炎症反应评分和平均动脉压及血生化指标.结果肝肾综合征患者降钙素原水平为6.98±12.38ng/L,高于对照组（0.12±0.10ng/L,P〈0.05）;肝肾综合征患者终末期肝功能评分为36.9±9.0,高于对照组（9.9±7.7,P〈0.05）;肝肾综合征患者血清总胆红素、尿素、肌酐、半胱氨酸蛋白酶抑制剂及血钾水平分别为296.4±233.8μmol/L、29.9±11.1mmol/L、417.1±97.4μmol/L、3.5±1.2mg/L 和4.78±0.89mmol/L,高于对照组（57.5±44.1μmol/L、4.6±1.0 mmol/L、69.2±10.3μmol/L、1.2±0.5mg/L和3.68±0.41mmol/L,P均〈0.05）,而血钠、血氯水平为127.9±6.5mmol/L和91.8±6.7mmol/L,明显低于对照组（138.26±3.94mmol/L、103.23±5.06mmol/L,P均〈0.05）.结论内毒素血症可能是肝肾综合征发生的关键因素.

Correlation of endotoxin and hepatorenal syndrome in patients with decompensated liver cirrhosis

Objective To study the correlation of endotoxin and hepatorenal syndrome （HRS） in patients with decompensated liver cirrhosis. Methods 38 patients with liver cirrhosis and type 1 HRS and 50 without were enrolled in this study. Clinical data,cirrhosis etiology,Child-Pugh score,model for end-stage liver disease（MELD） score,systemic inflammatory response（SIRS）score and mean arterial pressure（MAP） in the two groups were record- ed;Blood samples were obtained for laboratory analysis of liver function, renal function,electrolyte and procalcitonin （PCT）. Results PCT level in HRS group （6.98 ± 12.38ng/L） were significantly （t value was 6.78,P〈0.05） higher than that in non-HRS group（0.12 ± 0.10ng/L） ; MELD score in HRS group was significantly higher （t= 10.70,P〈0.05 ） than that in non-HRS group, while MAP was significantly lower （t=3.86,P〈0.05）;the levels of serum total bilirubin, direct bilirubin,urea,creatinine,cystatin C and potassium in HRS group were significantly higher （t values were 4.62,4.78,12.90,20.13,7.25 and 6.06 respectively,P〈0.05） than those in non-HRS group,while levels of serum sodium and chlorine were significantly lower （t values were 7.09 and 6.95,P〈0.05）. Conclusion Endotoxemia may be the key factor in the development of HRS in patients with liver cirrhosis.