【摘要】 目的探讨肝功能指标对脓毒症患者预后预测价值。方法选择2017年2月至2019年5月在山西医科大学第二临床医学院接受治疗的108例脓毒症患者进行回顾性分析。收集患者肝功能指标:谷丙转氨酶(ALT)、谷草转氨酶AST)、γ-谷氨酰转肽酶(GGT)、白蛋白(ALB)、胆碱酯酶(CHE)、总胆红素(TBiL)、总胆汁酸(TTBA)及前白蛋白(PA)及APACHEⅡ评分。根据患者APACHEⅡ评分将其分为三组,<15分者为A组,15～20分者为B组,> 20分者为C组,对比各组患者肝功能指标。再根据患者28 d预后情况将其分为存活组与死亡组,对比各组患者肝功能指标。并将肝功能指标与APACHEⅡ评分进行相关性分析,以ROC曲线分析肝功能指标对脓毒症患者死亡的预测价值。结果不同APACHEⅡ评分患者GGT、PA水平对比差异无统计学意义(P> 0. 05),不同APACHEⅡ评分患者ALT、AST、TBiL及TBA水平差异具有统计学意义,且A组> B组> C组(P <0. 05);不同APACHEⅡ评分患者ALB与CHE水平差异均具有统计学意义,且A组<B组<C组(P <0. 05)。不同预后情况患者GGT、PA水平对比差异无统计学意义(P> 0. 05),生存组ALT、AST、TBiL、TBA及APACHEⅡ评分均明显低于死亡组,生存组ALB与CHE均明显高于死亡组(P <0. 05)。相关性分析结果显示,GGT、PA与APACHEⅡ评分不具有显著相关性(P> 0. 05),ALT、AST、TBiL及TBA均与APACHEⅡ评分呈显著正相关关系(r> 0,P <0. 05); ALB及CHE均与APACHEⅡ评分呈显著负相关关系(r <0,P <0. 05)。ROC分析结果显示肝功能指标中除GGT、PA对脓毒症患者死亡预测价值不具有统计学意义(P> 0. 05)外,ALT、AST、ALB、CHE、TBiL及TBA对脓毒症患者死亡预测价值均具有统计学意义,且联合诊断可明显提高诊断敏感度及特异性(P <0. 05)。结论 ALT、AST、ALB、CHE、TBiL及TBA对脓毒症患者死亡具有较高的预测价值,且上述指标联合检测可提高预测的敏感度及特异性,临床上可通过检测上述指标以预测脓毒症患者预后,为治疗方案的选择提供参考依据。更多还原

【Abstract】 Objective To investigate the prognostic value of liver function indicators in patients with sepsis. Methods A retrospective analysis of 108 patients with sepsis who were treated in our hospital from February 2017 to May 2019 was performed.Collect liver function indicators: alanine aminotransferase( ALT),aspartate aminotransferase( AST),gamma-glutamyltranspeptidase( GGT),albumin( ALB),cholinesterase( CHE),total bilirubin( TBiL),total bile acid( TTBA) and prealbumin( PA) and APACHE II scores. According to the APACHE Ⅱ score of patients,they were divided into 3 groups,those with < 15 points were group A,those with 15-20 points were group B,and those with > 20 points were group C. Comparing the liver function indicators of each group. And then according to the 28-day prognosis of patients,they were divided into survival group and death group,the liver function indicators of each group were compared. The correlation between liver function index and APACHE II score was analyzed,and the ROC curve was used to analyze the predictive value of liver function index for death in patients with sepsis. Results There was no significant difference in GGT and PA levels between the APACHE II scores( P > 0. 05). The differences in ALT,AST,TBIL and TBA levels were statistically significant in different APACHE II scores,and A > GroupB > GroupC( P < 0. 05); The difference of ALB and CHE levels in patients with different APACHE II scores was statistically significant,and Group A < Group B < Group C( P < 0. 05). There was no significant difference in GGT and PA levels among patients with different prognosis( P > 0. 05). The ALT,AST,TBiL,TBA and APACHE II scores in survival group were significantly lower than those in death group,and ALB and CHE in survival group were significantly higher than those in death group( P < 0. 05). Correlation analysis showed that GGT,PA and APACHE II scores were not significantly correlated( P > 0. 05),and ALT,AST,TBiL and TBA were significantly positively correlated with APACHE II score( r >0,P < 0. 05). Both ALB and CHE showed a significant negative correlation with APACHE II score( r < 0,P < 0. 05). ROC analysis showed that the predictive value of GGT and PA in patients with sepsis was not statistically significant( P > 0. 05),and ALT,AST,ALB,CHE,TBiL and TBA were predicting death in patients with sepsis. The values were statistically significant and combined diagnosis significantly improved diagnostic sensitivity and specificity( P < 0. 05). Conclusion ALT,AST,ALB,CHE,TBiL and TBA have high predictive value for death in patients with sepsis. Combined detection of the above indicators can improve the sensitivity and specificity of the prediction. Clinically,the above indicators can be used to predict pus. The prognosis of patients with toxic diseases provides a reference for the choice of treatment options.更多还原