肝脏
肝髒
간장
CHINESE HEPATOLOGY
2014年
6期
407-411
,共5页
郑茵%彭稢%陈金军%侯金林
鄭茵%彭稢%陳金軍%侯金林
정인%팽욱%진금군%후금림
肝硬化%失代偿期%感染%预后
肝硬化%失代償期%感染%預後
간경화%실대상기%감염%예후
Decompensated liver cirrhosis%Infection%Prognosis
目的：通过临床常用感染指标探讨对失代偿性肝硬化患者预后预测作用。方法回顾性分析广州市南方医院2009年1月至2013年4月住院且病例资料及随访结果完整的失代偿期肝硬化357例，记录其入院及住院期间的WBC计数，中性粒细胞（NE）和淋巴细胞（LYM）比值，C反应蛋白（CRP）水平和血小板（PLT）计数。随访患者入院90 d后的生存情况。比较死亡与生存患者入院及住院期间各指标，Logistic分析确定死亡危险因素，用Kaplan-Meier分别绘制生存曲线，Log-Rank检验生存率差异。结果94例患者入院90 d 后死亡。死亡组 WBC 计数、NE 和LYM比值入院及住院期间各指标分别为：（8．45±0．55）×109/L、（72．33±1．16）％和（16．36±0．81）％、（9．17±0．64）×109/L 及（71．24±1．31）和（16．39±0．87）％、（13．55±0．83）×109/L及（83．38±0．92）和（22．68±0．84）％，（5．88±0．33）×109/L及（63．05±1．23）和（8．58±0．48）％，对比生存组相应各指标分别为：（6．84±0．26）×109/L 及（65．67±0．89）和（23．01±0．75）％、（6．05±0．21）×109/L 及（61．53±0．83）和（25．50±0．68）％、（9．09±0．36）×109/L 及（73．03±0．89）和（34．48±0．81）％、（4．20±0．14）×109/L 及（50．95±0．87）和（16．89±0．64）％，P 值均＜0．01。入院短期内CRP水平升高和PLT计数降低的幅度死亡组较生存组大。多变量分析结果住院期间临床上诊断感染，终末期肝病模型（MELD）评分和LYM比值基线值为90 d死亡的独立危险因素。住院时并发感染或LYM比值基线值低于17．4％的患者90 d生存率分别低于其他患者（均P＜0．01）。结论 WBC计数和NE、LYM比值，CRP 水平和PLT 计数的短期变化幅度与失代偿性肝硬化患者短期预后相关。
目的：通過臨床常用感染指標探討對失代償性肝硬化患者預後預測作用。方法迴顧性分析廣州市南方醫院2009年1月至2013年4月住院且病例資料及隨訪結果完整的失代償期肝硬化357例，記錄其入院及住院期間的WBC計數，中性粒細胞（NE）和淋巴細胞（LYM）比值，C反應蛋白（CRP）水平和血小闆（PLT）計數。隨訪患者入院90 d後的生存情況。比較死亡與生存患者入院及住院期間各指標，Logistic分析確定死亡危險因素，用Kaplan-Meier分彆繪製生存麯線，Log-Rank檢驗生存率差異。結果94例患者入院90 d 後死亡。死亡組 WBC 計數、NE 和LYM比值入院及住院期間各指標分彆為：（8．45±0．55）×109/L、（72．33±1．16）％和（16．36±0．81）％、（9．17±0．64）×109/L 及（71．24±1．31）和（16．39±0．87）％、（13．55±0．83）×109/L及（83．38±0．92）和（22．68±0．84）％，（5．88±0．33）×109/L及（63．05±1．23）和（8．58±0．48）％，對比生存組相應各指標分彆為：（6．84±0．26）×109/L 及（65．67±0．89）和（23．01±0．75）％、（6．05±0．21）×109/L 及（61．53±0．83）和（25．50±0．68）％、（9．09±0．36）×109/L 及（73．03±0．89）和（34．48±0．81）％、（4．20±0．14）×109/L 及（50．95±0．87）和（16．89±0．64）％，P 值均＜0．01。入院短期內CRP水平升高和PLT計數降低的幅度死亡組較生存組大。多變量分析結果住院期間臨床上診斷感染，終末期肝病模型（MELD）評分和LYM比值基線值為90 d死亡的獨立危險因素。住院時併髮感染或LYM比值基線值低于17．4％的患者90 d生存率分彆低于其他患者（均P＜0．01）。結論 WBC計數和NE、LYM比值，CRP 水平和PLT 計數的短期變化幅度與失代償性肝硬化患者短期預後相關。
목적：통과림상상용감염지표탐토대실대상성간경화환자예후예측작용。방법회고성분석엄주시남방의원2009년1월지2013년4월주원차병례자료급수방결과완정적실대상기간경화357례，기록기입원급주원기간적WBC계수，중성립세포（NE）화림파세포（LYM）비치，C반응단백（CRP）수평화혈소판（PLT）계수。수방환자입원90 d후적생존정황。비교사망여생존환자입원급주원기간각지표，Logistic분석학정사망위험인소，용Kaplan-Meier분별회제생존곡선，Log-Rank검험생존솔차이。결과94례환자입원90 d 후사망。사망조 WBC 계수、NE 화LYM비치입원급주원기간각지표분별위：（8．45±0．55）×109/L、（72．33±1．16）％화（16．36±0．81）％、（9．17±0．64）×109/L 급（71．24±1．31）화（16．39±0．87）％、（13．55±0．83）×109/L급（83．38±0．92）화（22．68±0．84）％，（5．88±0．33）×109/L급（63．05±1．23）화（8．58±0．48）％，대비생존조상응각지표분별위：（6．84±0．26）×109/L 급（65．67±0．89）화（23．01±0．75）％、（6．05±0．21）×109/L 급（61．53±0．83）화（25．50±0．68）％、（9．09±0．36）×109/L 급（73．03±0．89）화（34．48±0．81）％、（4．20±0．14）×109/L 급（50．95±0．87）화（16．89±0．64）％，P 치균＜0．01。입원단기내CRP수평승고화PLT계수강저적폭도사망조교생존조대。다변량분석결과주원기간림상상진단감염，종말기간병모형（MELD）평분화LYM비치기선치위90 d사망적독립위험인소。주원시병발감염혹LYM비치기선치저우17．4％적환자90 d생존솔분별저우기타환자（균P＜0．01）。결론 WBC계수화NE、LYM비치，CRP 수평화PLT 계수적단기변화폭도여실대상성간경화환자단기예후상관。
Objective To evaluate the prognostic roles of several widely clinical available laboratory parameters for infection in patients with decompensated liver cirrhosis. Methods Three hundred and fifty-seven in inpatients with decompensated liver cirrhosis admitted to in Nanfang Hospital,Southern Medical University in Guangzhou from January 2009 to April 2013 were retrospectively enrolled. White blood cell (WBC)count,neutrophil (NE)and lymphocyte (LYM)percent,C-reactive protein (CRP)level and platelet (PLT)count were serially recorded on admission and during hospitalization. The primary end point was 90-day mortality. Potential predictors of mortality were compared between survivors and non-survivors,while those with significant differences between groups were included in logistic analyses. Independent risk factors affecting prognosis were evaluated using the Kaplan-Meier method and compared with Log-Rank test. Results In all,94 patients died within 90 days after admission. Serial measurements of WBC count and NE percent were significantly higher,while LYM percent was lower in non-survivors compared with survivors:(8.45±0.55)×109/L,(72.33±1.16)and (16.36±0.81)% ,(9.17±0.64)×109/L,(71.24±1.31)and (16.39±0.87)% ,(13.55± 0.83)×109/L,(83.38±0.92)and (22.68±0.84)% ,(5.88±0.33)×109/L,(63.05±1.23)and (8.58±0.48)% in non-survivors compared with (6.84±0.26)×109/L,(65.67±0.89)and (23.01±0.75)% ,(6.05±0.21)×109/L, (61.53±0.83)and (25.50±0.68)% ,(9.09±0.36)×109/L,(73.03±0.89)and (34.48±0.81)% ,(4.20±0.14)× 109/L,(50.95±0.87)and (16.89±0.64)% in survivors,respectively,P <0.01 for all. A large increase in CRP leveland a further decrease in PLT count after an initial period from admission were observed in non-survivors compared with survivors. Multivariable analyses indentified diagnosis of infection in hospitalization,baseline of Model for End-stage Liver Disease (MELD)score and LYM percent as independent predictors of 90-day mortality. Patients with infection during hospital stay or LYM percent ≤1 7 .4% on admission have significantly less survival than those without infection (P<0.01 for both). Conclusions WBC count,NE and LYM percent,together with the magnitude of the change in CRP level and PLT count were all significantly correlated with short-term mortality in patients with decompensated liver cirrhosis.
