肝硬化伴自发性细菌性腹膜炎患者血清降钙素原与1型肝肾综合征的关系

目的：研究肝硬化伴自发性细菌性腹膜炎（SBP）患者血清降钙素原（PCT）的变化，并探讨其与1型肝肾综合征（HRS）的关系。方法2011年1月至2013年11月收治的肝硬化伴腹水患者150例，其中单纯腹水（非SBP组）47例，住院期间无HRS发生；肝硬化并发SBP103例，其中1周内并发1型HRS患者28例（HRS组），另75例住院期间肾功能均正常（SBP组）。150例患者均于入院当天（即第1天）和人院后第3、5、7天抽取外周静脉血测PCT、C- CRP，同时测肝肾功能、血常规,并绘制受试者工作特征（ROC）曲线。结果肝硬化SBP组及HRS组入院第1、3、5、7天的PCT水平均明显高于非SBP组，差异均有统计学意义（均P＜0.05）；HRS组入院第1、3、5、7天PCT水平明显高于单纯SBP组，差异均有统计学意义（均P＜0.05）；SBP组经过治疗1周内病情有不同程度改善，PCT水平也逐渐下降，HRS组治疗效果差，1周内PCT水平逐渐升高。肝硬化伴SBP患者入院第1天检测的PCT、CRP及常规肾功能指标预测1型HRS的ROC曲线AUC依次为PCT 0.904、CRP 0.742、血尿素氮（BUN）0.724、血清肌酐（Scr）0.659，即PCT＞CRP＞BUN＞Scr。假定检测的灵敏度与特异性同等重要，以两者之和最大值时对应的浓度为截断点，PCT的诊断灵敏度，特异性最高。结论持续监测PCT可评估肝硬化伴SBP患者的严重程度及预后，并可预警HRS发生，从而可以提早实施干预措施。

Relationship between serum procalcitonin and type 1 hepatorenal syndrome in cirrhotic patients with spontaneous bacterial peritonitis

Objective To investigate the relationship between serum procalcitonin （PCT） levels and type 1 hepatorenal syndrome （HRS） in cirrhotic patients with spontaneous bacterial peritonitis （SBP）. Methods One hundred and fifty cirrhotic pa-tients with ascites were admitted in hospital from January 2011 to November 2013, including 47 cases without SBP （non- SBP group） and 103 cases with SBP, among whom 28 cases developed type 1 HRS within 1 week after admission（HRS group） and 75 cases had no HRS （SBP group）. Serum PCT, C- reactive protein （CRP）, white blood cell（WBC） count were measured and liver function, renal function were determined at d1, 3, 5 and 7 d after admission. Results Serum PCT levels in SBP group and HRS group were significantly higher than those of non- SBP group （P＆lt;0.05）;and in HRS group were significantly higher than those of SBP group （P＆lt;0.05） at al time points. PCT levels in SBP group were gradual y decreased with condition improved;or gradual y increased with the disease progression in 1 week. For predicting type 1 HRS in cirrhotic patients with SBP the area under the re-ceiver operating characteristic curve （AUC） of PCT, CRP, BUN and Scr were 0.904, 0.742, 0.724 and 0.659, respectively. Taking cut- off of 1.61 the sensitivity and specificity of serum PCT for predicting HRS were 82% and 86%, respectively. Conclusion Continuous monitoring serum PCT levels can assess the disease severity and predict the occurrence of type 1 HRS in cirrhotic patients with SBP.