降钙素原在非感染的终末期肝病患者中的表达水平及影响因素

目的 探讨血清降钙素原(PCT)在非感染的终末期肝病患者中的表达水平及影响因素。 方法 收集终末期肝病(失代偿期肝硬化或肝衰竭)且未合并感染的患者207例,回顾性分析患者的临床资料。同时以非感染的代偿期肝硬化患者43例作为对照组,单因素方差分析比较各组患者的PCT基线水平,Spearman等级相关分析法判断PCT水平与各指标的相关性。 结果 代偿期肝硬化组、失代偿期肝硬化组及肝衰竭组患者的血清PCT水平分别为(0.08±0.013),(0.20±0.019)及(0.76±0.051)ng/mL,3组间比较差别有统计学意义(F=83.646,P<0.001)。相关分析显示,PCT水平与代偿期肝硬化、终末期肝病非感染患者的总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、终末期肝病模型(MELD)评分(r分别为0.741,0.669,0.725及0.691,P<0.001)均呈正相关关系:失代偿期肝硬化组中,血清PCT水平与TBIL,ALT,AST及MELD评分的相关系数分别为0.492,0.468,0.569及0.202(P<0.05); 肝衰竭组中,血清PCT水平与ALT,AST,MELD的相关系数分别为0.365,0.329,0.262(P<0.05); 代偿期肝硬化组中,PCT水平与ALT及AST的关系差别并无统计学意义。 结论 在不伴随感染的终末期肝病患者中,血清PCT表达水平升高,并与肝功能指标呈正相关。当PCT用于这类人群进行感染的诊断时,要考虑肝功能状态对PCT基线水平的影响。

Study on the Baseline Level and Impact Factors of Procalcitonin in Non-infected Patients with End-stage Liver Disease

Objective To explore the expression and impact factors of procalcitonin(PCT)in non-infected patients with end-stage liver diseases. Methods 207 non-infected patients with end-stage liver diseases(liver failure or decompensated cirrhosis)were retrospectively enrolled and 43 non-infected patients with compensated cirrhosis were selected as control group. One-way ANOVA analysis was applied to compare the baseline level of PCT of each group and Spearman correlation analysis was used to study the relation between serum PCT and indexes for liver diseases. Results The baseline PCT levels in patients with compensated cirrhosis, decompensated cirrhosis and liver failure were(0.08±0.013)ng/mL,(0.20±0.019)ng/mL and(0.76±0.051)ng/mL respectively. The differences between three groups were statistically significant(F=83.646,P<0.001). According to the Spearman correlation analysis, the baseline levels of PCT in non-infected patients with liver diseases were strong positively correlated with total bilirubin(TBIL), alanine aminotransferase(ALT), aspartate transaminase(AST), end-stage liver disease model(MELD)(r=0.741, 0.669, 0.725 and 0.691, respectively, P<0.01). Especially in patients with non-infected end-stage liver disease: the PCT levels in non-infected patients with decompensated cirrhosis were positively correlated with TBIL(r=0.492), ALT(r=0.468), AST(r=0.569), MELD(r=0.202), all P<0.05. The PCT levels in non-infected patients with liver failure were positively correlated with ALT(r=0.365), AST(r=0.329)and MELD(r=0.262), all P<0.05. However, the PCT levels in patients with compensated cirrhosis were not significantly correlated with ALT and AST(P>0.05). Conclusion PCT levels are elevated and positively associated with liver function indicators in non-infected patients with end-stage liver diseases. The impact of liver function state on baseline PCT level should be taken into consideration when PCT serves as a diagnostic marker for bacterial infection in patients with end-stage liver diseases.