肝硬化并发肾上腺皮质功能不全患者的临床特点分析

摘要

Objective To evaluate the baseline level of corticosteroid and adrenocorticotrophic hormone (ACTH) in patients with cirrhosis and to investigate the clinical characteristics in patients with cirrhosis complicated with adrenal insufficiency(AI). Methods The basal level of corticosteroid and ACTH in 118 liver cirrhosis cases, who were hospitalized in the Department of Gastroenterology in our hospital were measured . Then the patients were divided into two groups as with or without AI. Clinical characteristics and prognosis of the two groups were analyzed. 30 cases of gastrointestinal polypus were selected as control. Results The serum corticosteroid in 118 cirrhosis patients was (329.67 ±136.1) nmol/L, that was lower than that (460.7 ± 165.48) nmol/L in the control group(t = -4.501, P<0.05). Of 118 cases of cirrhosis, there were 32 cases combining AI and the propotion of them was 27. 1% (32/118) . In addition, spontaneous bacterial peritonitis (SBP) complication rates, Child pugh grades and scores, MELD scores and fatality rates of 32 liver cirrhosis cases with AI are all higher than that in the cases without AI( P <0.05). The level of albumin and high density lipoprotein - cholesterol was lower and the incidence rates of pigmentation , ascites and spontaneous bacterial peritonitis (SBP) are significantly higher (P < 0.05). But there was no statistically significant difference in other clinical characteristics and laboratory parameters ( P > 0. 05). Conclusion The level of corticoate-roid and ACTH in cirrhosis patients is lower, and about 27% cirrhosis cases are complicated with AI, these patients have higher incidence rate of SBP, worse hepatic function and higher mortality,leading to poor prognosis.%目的 了解肝硬化患者的血清基础皮质醇及促肾上腺皮质激素(ACTH)水平,探讨肝硬化患者并发肾上腺皮质功能不全(AI)的临床意义及特点.方法 118例肝硬化患者用化学发光方法测量血清基础皮质醇及ACTH水平,然后将其分为并发AI组和未并发AI组,前瞻性地分析两组患者的临床特点及预后.同期选取30名胃肠息肉患者为对照组.结果 本组肝硬化患者基础皮质醇水平为(329.67±136.1)nmoL/L,显著低于对照组的(460.7±165.48)nmol/L(t=-4.501,P＜0.05).肝硬化中并发AI者32例占27.1％(32/118),AI组与未并发AI的肝硬化患者比较,在并发自发性腹膜炎(SBP)、Child分级、Child评分、MELD评分及病死率方面明显增高,两组差异有统计学意义(P＜0.05)；32例并发AI的肝硬化患者白蛋白、高密度脂蛋白-胆固醇(HDL-C)水平明显减低,出现面部色素沉着及腹水的发生率较高(P＜0.05),然而其他临床特点及实验室指标,两组差异无统计学意义.结论 肝硬化患者基础皮质醇水平明显减低,并发A1的患者SBP的发生率高、肝损伤的严重、病死率增加,严重影响预后.