CAJ | 학술논문

目的探讨降钙素原检测在终末期肝衰竭患者发生急性肾损伤中的价值.方法病例对照研究.收集四川大学华西医院2009年1月至2012年1月90例住院患者临床资料,其中终末期肝衰竭伴急性肾损伤患者40例(急性肾损伤组),终末期肝衰竭且肾功能正常患者50例(对照组).记录两组患者年龄、性别、肝衰竭病因、Child-pugh分级、终末期肝病模型(model for end-stage liver disease,MELD)评分、感染发生率及类型及全身炎性反应(systemic inflammatory response,SIRS)评分.同时采集两组患者血液,采用罗氏Modular-P800全自动生化分析仪检测肾功能并采用罗氏Cobas E170全自动电化学发光分析仪检测降钙素原水平.比较两组患者的临床资料和检测指标.计数资料采用x2检验;正态分布计量资料采用成组资料的t检验;非正态分布计量资料采用Wilcoxon秩和检验.急性肾衰竭组降钙素原水平与肾功能指标的相关性采用Spearman秩相关分析.结果急性肾损伤组感染发生率为82.5％,高于对照组的26.0％,差异有统计学意义(x2=26.68,P＜0.05).急性肾损伤组降钙素原水平和SIRS评分分别为8.72(3.14,31.68) μg/L和2.15±1.11,高于对照组的0.11(0.04,0.45) μg/L和0.67±0.59 (H=81,t =6.36,P＜0.05).急性肾损伤组降钙素原与尿素显示较好的相关性(r =0.67,P＜0.05).结论终末期肝衰竭并发急性肾损伤患者感染率和降钙素原水平增高,提示感染引发的脓毒血症与终末期肝衰竭患者发生急性肾损伤密切相关,降钙素原检测对终末期肝衰竭患者急性肾损伤的发生有提示作用.
목적 탐토강개소원검측재종말기간쇠갈환자발생급성신손상중적개치.방법 병례대조연구.수집사천대학화서의원2009년1월지2012년1월90례주원환자림상자료,기중종말기간쇠갈반급성신손상환자40례(급성신손상조),종말기간쇠갈차신공능정상환자50례(대조조).기록량조환자년령、성별、간쇠갈병인、Child-pugh분급、종말기간병모형(model for end-stage liver disease,MELD)평분、감염발생솔급류형급전신염성반응(systemic inflammatory response,SIRS)평분.동시채집량조환자혈액,채용라씨Modular-P800전자동생화분석의검측신공능병채용라씨Cobas E170전자동전화학발광분석의검측강개소원수평.비교량조환자적림상자료화검측지표.계수자료채용x2검험;정태분포계량자료채용성조자료적t검험;비정태분포계량자료채용Wilcoxon질화검험.급성신쇠갈조강개소원수평여신공능지표적상관성채용Spearman질상관분석.결과 급성신손상조감염발생솔위82.5％,고우대조조적26.0％,차이유통계학의의(x2=26.68,P＜0.05).급성신손상조강개소원수평화SIRS평분분별위8.72(3.14,31.68) μg/L화2.15±1.11,고우대조조적0.11(0.04,0.45) μg/L화0.67±0.59 (H=81,t =6.36,P＜0.05).급성신손상조강개소원여뇨소현시교호적상관성(r =0.67,P＜0.05).결론 종말기간쇠갈병발급성신손상환자감염솔화강개소원수평증고,제시감염인발적농독혈증여종말기간쇠갈환자발생급성신손상밀절상관,강개소원검측대종말기간쇠갈환자급성신손상적발생유제시작용.
Objective To explore the role of procalcitonin (PCT) test in patients with end stage liver disease(ESLD) complicated with acute kidney injury (AKI).Methods This is a case control study.Between January 2009 and January 2012,40 ESLD inpatients with AKI were enrolled in AKI group while 50 ESLD inpatients with normal renal function were included in control group.Clinical data such as age,gender,etiology of liver failure,infection rates and types,child-pugh classification,model for endstage liver disease(MELD) score and systemic inflammatory response(SIRS) score of the two groups were recorded.Serum renal function were tested via Roche Modular-P800 automatic biochemical analyzer and PCT were tested via Roche E170 automatic electrochemical luminescence analyzer.Count data were analyzed by chi-square test,normal distribution measurement data were analyzed by student t test and non-normal distribution measurement data were analyzed by Wilcoxon rank sum test.Spearman correlation analysis between PCT and renal function was performed in AKI group.Results Infection rates of AKI group (82.5 ％) was significantly(x2 =25.68,P ＜ 0.05) higher than that of control group (26.0％).PCT level and SIRS score of AKI group [8.72(3.14,31.68) μg/L and 2.15 ± 1.11] were significantly (H and t values were 6.78 and 6.36 respectively,P ＜ 0.05) higher than those of control group [0.11 (0.04,0.45) μg/L,and 0.67 ± 0.59].In AKI group,PCT and urea performed were well related (r =0.67,P ＜0.05).Conclusion Elevated infection rate and PCT level in ESLD patients with AKI suggest that infection and consequent sepsis are closely associate with AKI in ESLD patients and elevated PCT level may indicate the high risk of AKI in patients with ESLD.