CAJ | 학술논문

目的：探讨血浆尾加压素Ⅱ与2型肝肾综合征（ HRS）患者预后的关系。方法选取2009年1月-2013年1月在温岭市第一人民医院住院、已明确诊断为2型HRS的患者78例，患者入院后即开始随访，随访时间为3个月。若患者在随访期间死亡，则纳入死亡组，否则纳入存活组。对比分析两组患者性别、年龄、合并症、终末期肝病模型（ MELD）评分、实验室检查〔包括丙氨酸氨基转移酶（ ALT）、总胆红素、清蛋白、血肌酐、白细胞计数、血红蛋白、血小板计数、C反应蛋白、血浆尾加压素Ⅱ及国际标准化比率（ INR）〕等。采用时间依存风险比例模型探讨2型HRS患者预后的影响因素。结果随访3个月时，存活组31例，死亡组47例。两组性别、年龄、消化道出血、肝性脑病、脓毒症、ALT、清蛋白、白细胞计数、血红蛋白、血小板计数、C反应蛋白和INR比较，差异均无统计学意义（P>0.05）。死亡组总胆红素、血肌酐、血浆尾加压素Ⅱ和MELD评分均高于存活组（P<0.01）。时间依存风险比例模型结果显示，血浆尾加压素Ⅱ、总胆红素和MELD评分均是2型HRS患者预后的影响因素（ P<0.05）。结论血浆尾加压素Ⅱ升高提示2型HRS患者预后不良。
목적：탐토혈장미가압소Ⅱ여2형간신종합정（ HRS）환자예후적관계。방법선취2009년1월-2013년1월재온령시제일인민의원주원、이명학진단위2형HRS적환자78례，환자입원후즉개시수방，수방시간위3개월。약환자재수방기간사망，칙납입사망조，부칙납입존활조。대비분석량조환자성별、년령、합병증、종말기간병모형（ MELD）평분、실험실검사〔포괄병안산안기전이매（ ALT）、총담홍소、청단백、혈기항、백세포계수、혈홍단백、혈소판계수、C반응단백、혈장미가압소Ⅱ급국제표준화비솔（ INR）〕등。채용시간의존풍험비례모형탐토2형HRS환자예후적영향인소。결과수방3개월시，존활조31례，사망조47례。량조성별、년령、소화도출혈、간성뇌병、농독증、ALT、청단백、백세포계수、혈홍단백、혈소판계수、C반응단백화INR비교，차이균무통계학의의（P>0.05）。사망조총담홍소、혈기항、혈장미가압소Ⅱ화MELD평분균고우존활조（P<0.01）。시간의존풍험비례모형결과현시，혈장미가압소Ⅱ、총담홍소화MELD평분균시2형HRS환자예후적영향인소（ P<0.05）。결론혈장미가압소Ⅱ승고제시2형HRS환자예후불량。
Objective To explore the relationship between plasma urotensinⅡand the prognosis of patients with type 2 hepatorenal syndrome(HRS). Methods From January 2009 to January 2013,in the First People's Hospital of Wenling,78 type 2 HRS patients had follow-up after admission,for 3 months. The patients who died during follow-up were enrolled in death group,those who did not die were enrolled in survival group. Patients' gender,age,complications,scores of model of end-stage liver disease(MELD),laboratory examinations were contrasted. The laboratory examinations included ALT,total bilirubin(TBiL),albumin(AL),creatinine(Cr),white blood cell(WBC),hemoglobin,platelet,C -reactive protein ( CRP),urotensin Ⅱ and international normalized ratio( INR). To explore the factors influencing type 2 HRS patients' prog-noses,time-dependent proportional hazard model was used. Results After 3 months follow-up,there were 31 patients in survival group,47 in death group. There was no significant difference in gender,age,gastrointestinal bleeding,hepatic en-cephalopathy,sepsis,ALT,AL,WBC,hemoglobin,platelets,CRP,INR between 2 groups(P>0. 05). TBiL,Cr,uro-tensin Ⅱ,MELD scores were higher in death group than in survival group ( P<0. 01 ). Time-dependent proportional hazard model showed that urotensin Ⅱ,TBiL,MELD scores were the factors influencing the prognoses of type 2 HRS patients( P<0. 05). Conclusion Elevated urotensin Ⅱ suggests poor prognoses of type 2 HRS patients.