摘要
目的:探讨血小板活化因子变化在慢性乙型重型肝炎预后评估中的临床价值.方法:将49例慢性乙型重型肝炎患者分为好转组(n=26)和死亡组(n=23),另选择20例健康体检者作为对照组.重型肝炎患者均采用综合治疗.分别检测治疗前和治疗后血清内毒素和人血小板活化因子值,统计慢性乙型重型肝炎患者死亡率.结果:49例慢性乙型重型肝炎患者内毒素血症发生率为85.71%(42/49),死亡组和好转组血清内毒素浓度均高于正常对照组(均P<0.01);好转组治疗后血清ET浓度明显低于治疗前(P<0.01);死亡组和好转组的血清PAF含量均高于正常对照组(均P<0.01);好转组治疗后血清PAF浓度明显低于治疗前(P<0.01);发生内毒素血症的患者PAF浓度明显高于未发生内毒素血症的患者(P<0.05);经Logistic回归分析,TBIL、ET、PAF与慢性乙型重型肝炎患者预后成正相关(P<0.05或0.01,OR=0.799、0.040、2.007),PTA与慢性乙型重型肝炎患者预后成负相关(P<0.05,OR=0.015),其中以PAF与预后的关系最为密切.结论:血小板活化因子下降与肝功能改善、临床表现好转有密切关系,慢性乙型重型肝炎患者血小板活化因子含量可作为评价重型肝炎预后的指标之一.
AIM： To evaluate the prognostic significance of serum platelet-activating factor （PAF） in chronic severe hepatitis B. METHODS： Forty-nine patients with chronic severe hepatitis B were divided into two groups： improvement group （n = 26） and death group （n = 23）. A control group was made up of 20 healthy individuals. All patients underwent combined therapy. The levels of PAF and en- dotoxin in the serum were detected before and after therapy. The case fatality of patients with chronic severe hepatitis B was calculated. RESULTS： The incidence rate of endotoxemia in 49 patients with chronic severe hepatitis B was 85.71% （42/49）. The serum endotoxin and PAF levels in the death group and improvement group were significantly higher than that in the control group （all P 〈 0.01）. The serum endotoxin and PAF levels were significantly lower in the improvement group after therapy than before therapy （both P 〈 0.01）. The serum PAF level in patients with endotoxemia was significantly higher than that in patients without endo-toxemia （P 〈 0.05）. Logistic regression analysis showed that total bilirubin, serum endotoxin and PAF levels were positively correlated with the prognosis of patient with chronic severe hepatitis B （all P 〈 0.01 or 0.05; OR = 0.799, 0.040 and 2.007, respectively）, and prothrombin activity was negatively correlated with the prognosis of patient with chronic severe hepatitis B （P 〈 0.05, OR = 0.015）. PAF is the best parameter to evaluate the prognosis of patient with chronic severe hepatitis B. CONCLUSION： A decrease in serum PAF level is closely associated with the improvement of hepatic function. Serum PAF level can be used as a prognostic factor in chronic severe hepatitis B.
出处
《世界华人消化杂志》
CAS
北大核心
2009年第36期3740-3744,共5页
World Chinese Journal of Digestology
