摘要
目的 探讨成人肝硬化感染性休克患者血氨水平变化情况.方法 选择90 例肝硬化感染性休克患者为观察组,同期59 例非肝硬化感染性休克患者为对照组,比较两组治疗前后及不同生存预后患者的血氨、血清降钙素原(PCT)、白细胞介素-6(IL-6)以及C反应蛋白(CRP)水平;比较观察组不同肝功能分级患者血氨、PCT、IL-6以及CRP水平;应用受试者工作特征(ROC)曲线评价血氨、PCT、IL-6以及CRP对肝硬化患者感染性休克预后的预测价值;分析观察组治疗前血氨与PCT、IL-6、CRP及肝功能分级的相关性.结果 治疗后观察组患者血氨、PCT、IL-6以及CRP均高于对照组(t分别=3.77、2.65、3.33、3.71,P均＜0.05);观察组存活患者血氨、PCT、IL-6以及CRP水平均明显低于死亡患者,差异均有统计学意义(t分别=3.23、2.61、2.54、2.43,P均＜0.05);两组存活患者中,观察组患者治疗前血氨、PCT、IL-6以及CRP水平相较于对照组更高(t分别=5.33、6.39、5.67、6.87,P均＜0.05);观察组患者Child分级中A级患者血氨、PCT、IL-6以及CRP水平均明显低于B级患者(t分别=4.13、2.21、2.08、2.21,P均＜0.05),B级患者明显低于C级患者(t分别=2.98、2.08、2.46、2.69,P均＜0.05).治疗前血氨预测肝硬化感染性休克预后截点值为37.71 µmol/L,曲线下面积(AUC)为0.82,灵敏度和特异度分别为66.67%、90.12%;血清PCT截点值为30.97 ng/mL,AUC为0.76,灵敏度和特异度分别为77.78%、67.90%;血清IL-6截点值为77.70 ng/mL,AUC为0.69,灵敏度和特异度分别为88.89%、55.56%;血清CRP截点值为64.23 mg/L,AUC为0.78,灵敏度和特异度分别为88.89%、54.32%;观察组治疗前PCT、IL-6以及CRP水平、Child分级与血氨水平呈正相关(r分别=0.67、0.88、0.57、0.55,P均＜0.05).结论 血氨水平与肝硬化感染性休克患者病情发展密切相关,其对肝硬化感染性休克患者早期临床诊断价值较高,且血氨水平与PCT、IL-6、CRP水平、Child分级呈正相关.
Abstract
Objective To explore the changes of blood ammonia level in adult patients with liver cirrhosis complicat-ed with septic shock.Methods A total of 90 patients with liver cirrhosis and septic shock were enrolled as observation group,and 59 patients with septic shock without liver cirrhosis were included in control group.The levels of blood ammo-nia,PCT,IL-6 and CRP were compared between two groups before and after treatment and among the patients with dif-ferent survival prognosis status.The levels of blood ammonia,PCT,IL-6 and CRP in patients with different liver function grades in observation group were compared.Receiver operating characteristic(ROC)curve was used to evaluate the pre-dictive value of blood ammonia,PCT,IL-6 and CRP on prognosis of septic shock in patients with liver cirrhosis.The cor-relation between blood ammonia and PCT,IL-6,CRP and liver function grading in observation group before treatment was analyzed.Results The levels of blood ammonia,PCT,IL-6 and CRP were higher in observation group(t=3.77,2.65,3.33,3.71,P＜0.05).The levels of blood ammonia,PCT,IL-6 and CRP of surviving patients in observation group were significantly lower than those of dead patients(t=3.23,2.61,2.54,2.43,P＜0.05).The levels of blood ammonia,PCT,IL-6 and CRP of surviving patients in observa-tion group before treatment were higher than those in control group(t=5.33,6.39,5.67,6.87,P＜0.05).In observation group,the levels of blood ammonia,PCT,IL-6 and CRP in Child grade A patients were significantly lower than those in grade B patients(t=4.13,2.21,2.08,2.21,P＜0.05),and the above levels were lower in grade B patients than those in grade C patients(t=2.98,2.08,2.46,2.69,P＜0.05).The cut-off value,area under the curve(AUC),sensitivity and specificity of blood ammonia were 37.71µmol/L,0.82,66.67%and 90.12%.The cut-off value,AUC,sensitivity and specificity of PCT were 30.97 ng/mL,0.76,77.78%and 67.90%.The cut-off value,AUC,sensitivity and specificity of IL-6 were 77.70 ng/mL,0.69,88.89%and 55.56%.The cut-off value,AUC,sensitivity and specificity of CRP were 64.23 mg/L,0.78,88.89%and 54.32%.The levels of PCT,IL-6,CRP and Child grading in observation group before treatment were positively correlated with blood ammonia level(r=0.67,0.88,0.57,0.55,P＜0.05).Conclusion Blood ammonia level is closely related to the disease progression in patients with liver cirrhosis and septic shock,and its value is high for early clinical diagnosis of patients with liver cirrhosis and septic shock.Moreover,blood ammonia level is positively correlated with PCT,IL-6,CRP levels and Child grading.
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