儿童急性肝衰竭血清降钙素原变化及其临床意义

目的 研究儿童急性肝衰竭血清降钙素原（procalcitionin,PCT）水平的变化,并探讨PCT与急性肝衰竭严重程度及预后的关系.方法 对2010年10月至2013年11月入住中国医科大学附属盛京医院小儿重症监护病房符合急性肝衰竭诊断标准的24例患儿血清PCT水平进行回顾性分析,同时检测血常规、C-反应蛋白、血培养、病毒及肺炎支原体抗体、血氨、血清谷丙转氨酶、血清谷草转氨酶、国际标准化比值及凝血酶原时间等指标变化.结果 急性肝衰竭患儿血清PCT有不同程度升高,其中21例患儿血清PCT大于0.5μg/L.6例患儿入院后第1天、第3天、第8天间断监测PCT,分别为（12.55±13.65） μg/L、（5.62 ±8.12） μg/L、（0.15 ±0.26） μg/L,PCT呈现下降趋势.24例急性肝衰竭患儿中,死亡组血清PCT、凝血酶原时间国际标准化比值、血氨明显高于存活组[（28.37±60.22） μg/L vs（12.24±14.76） μg/L;4.28 ±2.50 vs 3.16±1.41; （213.30±185.87） μmol/L vs（128.89 ±102.17） μmol/L] （P ＜0.05）.结论 急性肝衰竭可引起血清PCT水平升高,血清PCT可能成为评价急性肝衰竭患儿肝功能状态、疗效和预后的有效指标.

The significance of serum procalcitionin in children with acute liver failure

Objective To study the changes of serum procaleitonin（PCT） in the children with acute liver failure,and to investigate the relationship between PCT and severity and prognosis of acute liver failure.Methods A retrospective analysis of 24 children with acute liver failure admitted in Shengjing Hospital Affiliated to China Medical University from October 2010 to November 2013 was performed.The changes of serum PCT,blood routine,C-reactive protein,blood culture,virus,Mycoplasma pneumoniae antibody,blood ammonia,serum alaninetransaminase,serum glutamic oxaloacetic transaminase,international normalized ratio and prothrombin time level were observed.Results The serum PCT of children with acute liver failure originally increased at different degree.The serum PCT of 21 cases was more than 0.5 μg/L.The dynamic monitoring results of serum PCT in 6 cases on day 1,day 3,and day 8 were （12.55 ± 13.65） μg/L,（5.62 ±8.12） μg/L,（0.15 ± 0.26）μg/L,respectively,which showed decrease tendency.In 24 children with acute liver failure,serum PCT,international normalized ratio,blood ammonia of survival cases were significantly decreased compared with death cases[（28.37 ±60.22） μg/L vs（12.24 ± 14.76） μg/L;4.28 ± 2.50 vs 3.16 ±1.41 ; （213.30 ± 185.87） μmol/L vs （128.89 ± 102.17） μmol/L] （P 〈 0.05）.Conclusion Acute liver failure could increase the levels of serum PCT.Serum PCT may be an effective index to evaluate liver function,curative effect and prognosis of patients with acute liver failure.