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目的 比较在败血症时,肝硬化患者与无肝硬化患者血清降钙素原(PCT)水平,探索PCT在肝硬化合并严重感染时的临床价值. 方法 将225例败血症患者分为无肝病组91例,肝硬化组80例,慢性肝病组54例,比较三组间患者PCT水平差异,并与相应的临床生物化学指标进行相关性分析.根据资料不同分别采用独立样本t检验、方差分析ANOVA法进行、Mann-Whitney U检验、x2检验和Spearman相关分析进行统计学分析.结果 肝硬化组PCT水平[0.84 (0.32～ 3.44) ng/ml]明显低于无肝病组[2.17 (0.70 ～ 9.18) ng/ml]和慢性肝病组[2.12 (0.33 ～ 13.61) ng/ml],P值均＜0.05,差异具有统计学意义;而无肝病组与慢性肝病组比较,P=0.616,差异无统计学意义.肝硬化Child-Pugh分级C级患者的PCT水平[1.25 (0.54 ～ 4.61)ng/ml]高于B级[0.33(0.14～ 1.31)],P=0.026,差异有统计学意义,这可能与C级患者更容易发生革兰阴性菌败血症相关.肝硬化组PCT水平与白细胞计数(WBC)和中性粒细胞百分比(N％)均存在正相关关系,相关系数r分别为0.312及0.228,P值均＜0.05;而无肝病组及慢性肝病组相关性分析显示P值均＞ 0.05,提示PCT水平与WBC、N％均无明显相关性. 结论 在败血症状态下,肝硬化患者的血清PCT水平低于无肝硬化患者,肝硬化患者PCT水平与WBC、N％均存在正相关关系.

Objective To assess the clinical value ofprocalcitonin in cirrhotic patients with severe infection by comparing the serum procalcitonin levels in those patients with and without liver cirrhosis when suffering from sepsis.Methods A total of 225 septic patients were included in the study,including 91 patients without hepatopathy,80 patients with cirrhosis,and 54 patients with chronic liver disease.The serum procalcitonin level was measured in all patients and statistically assessed for correlation with relevant clinical biochemistry indicators.The t-test,ANOVA test,Mann-Whitney U test,chi-square test and Spearman's correlation analysis were used for statistical analyses.Results The patients with cirrhosis showed significantly lower serum procalcitonin levels (0.84 (0.32-3.44) ng/ml) than the patients with no hepatopathy (2.17 (0.70-9.18) ng/ml) or the patients with chronic liver disease (2.12 (0.33-13.61) ng/ml) (both P ＜ 0.05); the patients in the no hepatopathy group and the chronic liver disease group showed statistically similar levels of serum procalcitonin (P =0.616).The patients with cirrhosis of Child-Pugh grade C showed significantly higher level of serum procalcitonin (1.25 (0.54-4.61) ng/ml) than those patients with Child-Pugh grade B (0.33 (0.14-1.31) ng/ml; P =0.026),suggesting that patients with Child-Pugh C stage cirrhosis may be more susceptible to gram-negative bacterial infection.In the cirrhosis group,serum procalcitonin level was positively correlated with white blood cell (WBC) count (r =0.312) and percentage of neutrophils (N％) (r =0.228) (both P ＜ 0.05).Correlation analysis of the no hepatopathy group and the chronic liver disease group showed no correlation between serum procalcitonin level and either WBC or N％.Conclusions Under the sepsis condition,cirrhotic patients have lower serum procalcitonin level than patients without cirrhosis,and the serum procalcitonin level is positively correlated with WBC count and N％.