肝硬化合并全身炎症反应综合征炎症介质水平变化及其临床意义

梁祎雯谢敏

肝硬化合并全身炎症反应综合征炎症介质水平变化及其临床意义

梁祎雯1谢敏2

目的探究肝硬化合并全身炎症反应综合征（SIRS）患者血清炎症因子水平变化及其临床意义。方法本研究收集2012年4月至2015年9月在我院治疗并符合标准的105例肝硬化伴SIRS患者，依据预后不同将患者分为好转组与死亡组，两组患者一般资料无明显差异，肝硬化患者出现SIRS后第1天、第3天、第5天、第7天测定血清CRP、PCT、IL-6、TNF-α水平，评估前述指标与患者预后之间的关系。结果两组患者出现SIRS第1天血清CRP、PCT、IL-6、TNF-α水平均无明显差异（P＞0.05），第3天好转组患者血清CRP明显低于死亡组（P＜0.05），而两组患者血清PCT、IL-6、TNF-α水平仍无明显差异（P＞0.05），好转组患者第5天与第7天血清CRP、PCT、IL-6、TNF-α水平均明显低于死亡组，差异有统计学意义（P＜0.05）。结论肝硬化伴SIRS患者血清CRP、PCT、TNF-α与IL-6均明显增高，CRP、PCT、TNF-α与IL-6均可作为肝硬化伴SIRS病情评估及预后判断指标，CRP较其他指标能更早反映此疾病好转情况。

肝硬化；炎症；细胞因子；预后

【Abstact】Objective To explore the clinical significance of serum inflammatory mediators in patients with liver cirrhosis complicated with systemic inflammatory response syndrome（SIRS）.Method The data of 105 patients diagnosed as liver cirrhosis with SIRS were collected from April 2012 to September 2015 in our hospital.They were divided into two groups according to different prognosis：improved group and death group. General information of the two groups were comparable.The serum CRP，PCT，IL-6，TNF-α levels of two groups were detected on day 1，day 3，day 5，day 7 after the emergence of SIRS.The relationship between serum CRP，PCT，IL-6，TNF-α levels and prognosis was analyzed.Results The serum CRP，PCT，IL-6，TNF-α levels of two groups had no significant difference on day 1 after the emergence of SIRS（P＞0.05）. The serum CRP level in improved group were lower than those in death group on day 3 after the emergence of SIRS（P＜0.05）.The serum PCT，IL-6，TNF-α levels of two groups had no significant difference on day 3 after the emergence of SIRS（P＞0.05）.The serum CRP，PCT，IL-6，TNF-α levels in improved group were lower than those in death group on day 5 and day 7 after the emergence of SIRS（P＜0.05）.Conclusion The serum CRP，PCT，IL-6，TNF-α level of patients who had liver cirrhosis with SIRS was significantly increased. The serum CRP，PCT，IL-6，TNF-α levels could be effective indexes to assess the condition and prognosis，while CRP might be a better one in reflecting earlier disease improvement.

【Key words】Liver cirrhosis；Inflammatory；Cytokines；Prognosis

全身炎症反应综合征（SIRS）是感染或非感染因素作用于机体免疫系统导致的机体过度炎症反应及凝血/纤溶系统紊乱的过程［1-2］。肝硬化患者肠道免疫屏障被破坏，肠道细菌过度生长及移位并产生大量细菌毒素，同时肝硬化患者血清C反应蛋白水平下降、活性降低，导致炎症介质大量释放并诱发炎症级联反应，最终导致SIRS或多器官功能衰竭（MODS）［3］。普通肝病患者SIRS发生率约为1%，肝硬化患者SIRS发病率高达30%～50%，肝硬化是导致SIRS危险因素之一［4］。同时SIRS可使肝硬化患者肝功能进一步恶化，增加各类并发症的发生率及患者的病死率。……