血清肾上腺髓质素前体诊断失代偿期肝硬化并发细菌感染及其预测短期预后的价值*

doi:10.3969/j.issn.1672-5069.2021.04.019

摘要/Abstract

摘要： 目的探讨血清肾上腺髓质素前体(pro-ADM)诊断失代偿期肝硬化(DC)并发细菌感染及预测短期预后的价值。方法 2016年1月～2017年12月在中国科学院大学宁波华美医院住院的DC患者229例,采用新型夹心免疫荧光分析法检测血清pro-ADM水平。采用多元Logistic回归分析影响感染的因素,应用受试者工作特性曲线(ROC)下面积(AUC)分析指标的预测能力。结果在229例DC患者中,发生感染60例(26.2%),28 d死亡14例(6.1%),90 d死亡28例(12.2%);感染组血清pro-ADM为13.0(12.3,13.7) nmol/L,显著高于无感染组(8.8(7.5,11.0)nmol/L,P<0.001);Logistic多因素回归分析显示血清pro-ADM、白细胞计数、C反应蛋白和MELD评分是预测DC患者发生感染的独立危险因素(P<0.05),而血清pro-ADM、白细胞计数和MELD评分是DC患者28 d死亡的影响因素(P<0.05);应用血清pro-ADM预测感染的AUC为0.674(95%可信区间为0.609～0.734),联合白细胞计数和C反应蛋白构建模型的AUC为0.787(95%可信区间为0.729～0.839)。结论检测血清pro-ADM对诊断肝硬化患者发生感染有一定的临床应用价值,血清pro-ADM水平显著升高可能预后不良。

关键词: 肝硬化, 肾上腺髓质素前体, 细菌感染, 短期预后

Abstract: Objective The aim of this study was to explore the value of serum pro-adrenomedullin (pro-ADM) levels in the diagnosis of bacterial infection and the prediction of short-term prognosis in patients with decompensated cirrhosis(DC). Methods 229 patients with DC were prospectively enrolled between January 2016 and December 2017 in Hwamei Hospital, University of Chinese Academy of Sciences. Serum pro-ADM levels were detected, ,and the value of serum pro-ADM in the diagnosis of infection and the prediction of 28-day mortality in patients with DC was analyzed. Results Out of the 229 DC patients, the bacterial infections occurred in 60 cases (26.2%), with the 28-day mortality of 6.1% and 90-day mortality of 12.2%; serum pro-ADM level in patients with bacterial infection was 13.0(12.3, 13.7) nmol/L, significantly higher than (8.8(7.5, 11.0)nmol/L, P<0.001) in patients without; the multivariate Logistic regression analysis showed that serum pro-ADM, peripheral white blood cell(WBC) counts, C-reactive protein (CRP) and MELD score were the independent risk factors for bacterial infection (P<0.05), and serum pro-ADM, WBC counts and MELD score were the independent risk factors for 28-day mortality (P<0.05); the AUC of serum pro-ADM level in predicting bacterial infection in patients with DC was 0.674(95% CI:0.609-0.734), and the AUC of combination of it with WBC counts and CRP was 0.787(95% CI:0.729-0.839). Conclusions The detection of serum pro-ADM levels might help diagnose the bacterial infection in patients with DC, and those with extremely increased serum pro-ADM levels hints poor prognosis.

Key words: Liver cirrhosis, Pro-adrenomedullin, Bacterial infection, Short-term survival

金苏素, 颜华东. 血清肾上腺髓质素前体诊断失代偿期肝硬化并发细菌感染及其预测短期预后的价值^*[J]. 实用肝脏病杂志, 2021, 24(4): 528-531.

Jin Susu, Yan Huadong. Increased serum pro-adrenomedullin level is helpful for the diagnosis of bacterial infection and indicator for poor short-term prognosis in patients with decompensated cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(4): 528-531.

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血清肾上腺髓质素前体诊断失代偿期肝硬化并发细菌感染及其预测短期预后的价值^*

Increased serum pro-adrenomedullin level is helpful for the diagnosis of bacterial infection and indicator for poor short-term prognosis in patients with decompensated cirrhosis

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