血清胆碱酯酶对慢性重型乙型肝炎预后的判断价值

Serum Cholinesterase values in predicting prognosis of chronic severe hepatitis

目的 探讨血清胆碱脂酶（Cholinesterase，ChE）对慢性重型乙型肝炎（慢重肝）预后的判断价值。方法 测定60例慢重肝及对照组30例乙肝后肝硬化失代偿病人血清TB、PT、Cr、ChE水平，并测算终末期肝病模型（Model forend—stage liver disease，MELD）分值；分析比较慢重肝存活组与死亡组ChE，MELD分值：比较分析慢重肝与乙肝后肝硬化失代偿病人的ChE，MELD分值。结果 慢重肝存活组ChE（3017．48±117．57）U／L，死亡组ChE（1852．14±66．08）U／L（t=4．6921，P〈0．001）；存活组MELD分值（34．55±6．71），死亡组为（41．11±6．62）（t=3．77，P〈0．001）：慢重肝MELD分值（37．37±7．80），乙肝后肝硬化失代偿为（24．53±6．49）（t=7．52，P〈0．001），但两组ChE则无显著的统计学差异（P〉0．05）。慢重肝伴肝性脑病和肝肾综合征与伴肝性脑病和自发性细菌性腹膜炎（SBP）ChE，MELD分值比较，ChE无显著差异（P〉0．05），MELD分值有非常显著差异（P〈0．001）。结论 ChE活性是判断严重肝病预后的一个重要指标，同时测定ChE与MELD分值对预测慢重肝的短期预后具有较好的互补作用。

Objective To explore predictive factors for the prognosis of chromic severe hepatitis. Methods serum bilirubin （TB）, prothrombin time （PT）, creatine （Cr）, and cholinesterase （ChE） were detected and an MELD score was calculated in 60 patients with chronic severe hepatitis and in 30 patients with decompensation of cirrhosis. The ChE value, the MELD score and their correlations in survival and death groups were analyzed. Results The ChE value in the survival group （3017.48±117.57） was significantly higher than that in the death group（1852.14±66.08） （t=4.6921, P〈0.001 ）. In contrast, the MELD score in the survival group （34.55±6.71） was significantly lower than that in the death group （41.11±6.62） （t=3.77, P〈0.001 ） The chronic severe hepatitis group （37.37±7.80） was significantly higher than that in the decompensation of cirrhosis group （24.53±6.49） （t=7.52, P〈0.001 ） . No ChE score difference was noticed between patients with hepatorenal syndrome and with hepatic encephalopathy group. However, a significant difference in the MELD score was noticed between them. Condusion Serum ChE is a useful predictor for the prognosis of chronic severe hepatitis. The MELD has complementary effect with the ChE and MELD detected at the same time.