围手术期肝硬化患者血清胆碱酯酶测定评估肝脏储备功能的意义

Value of Serum Cholinesterase Activity (CHE) in Evaluating Liver Reserve Function of Cirrhotic Patients Perioperatively

目的分析围手术期血清胆碱酯酶评估肝硬化肝脏储备功能的临床意义。方法本院1996至2005年间肝硬化患者72例,对其进行门奇静脉断流术66例的病人进行回顾性分析,术前诊断乙型肝炎后肝硬化60例(A组),丙型肝炎后肝硬化4例(B组),酒精性肝硬化2例(C组)。另取同期收治的胃肠疾病患者40例为对照组(D组)。结果随着患者血清白蛋白(ALB)水平的下降,血清胆碱酯酶的活性也出现降低,A～D组分别为(3460±835)U/L(ALB≥35g/L)、(2730±920)U/L(ALB30～35g/L)、(2190±866)U/L(ALB25～30g/L)、(2134±672)U/L(ALB<25g/L),各组间有统计学差异;血清胆碱酯酶随着肝脏功能的下降,胆碱酯酶也出现相应的降低,其中ChildC级组与ChildB级组、ChildB级组与ChildA级组之间存在着统计学差异(P<0.05)。手术前肝功能评估为ChildA级,手术后肝功能分级分别为ChildA级、ChildB级、ChildC级的患者手术前血清胆碱酯酶活性存在统计学差异(P<0.05),同样手术前肝功能评估为ChildB级,手术后肝功能分级分别为ChildB级、ChildC级的患者手术前血清胆碱酯酶活性也存在统计学差异(P<0.05)。术后肝功能分级为ChildC级患者无论手术前为ChildA级、ChildB级还是ChildC级,手术前血清胆碱酯酶活性均无统计学差异。术后出现腹水、肝性脑病、黄疸等并发症的患者术与未出现明显并发症的患者比较,两组间血清胆碱酯酶活性统计学差别呈显著性(P<0.05)。接受手术的66名患者中,有5人术后出现肝昏迷,一例严重者死亡,术前血清胆碱酯酶均低于1900U/L。结论血清胆碱酯酶活性与慢性肝病肝脏的严重程度相一致,可以作为临床评价肝储备功能的手段之一。通过检测血清胆碱酯酶活性来评估肝脏储备功能可弥补传统的Child分级的不足。

[Obiective]To observe the value of serum cholinesterase activity （CHE） in evaluating liver reserve function of cirrhotic patients perioperatively. [Methods]Retrospective analyses of 72 cirrhotic patients and 66 cirrhotic patients undergoing pericardial devascularization were made in our hospital from 1995 to 2005. [Results]With serum albumin decreasing , serum CHE decreased too , serum CHES of group A（ n = 60）, group B（ n =4） and group C（ n =2） group D（ n =40） were （3 460±835） u/L（ALB≥35 g/L） ,（2 730±920） U/L（ALB30～35 g/L）,（2 190±866） U/L（ALB 25～30 g/L）,（2 134±672） U/L（ALB%25 g/L）respectively,compared each other, there was statistical significance of serum CHE among four groups, With liver function descending , the serum CHE decreased too . Child C group and Child B group,Child B group and Child A group reached statistical significance （ P〈0.05） . Serum CHE reached statistical significance （ P 〈 0.05） ,when preoperative hepatic function grade was ChildA , postoperative hepatic function grade was Child A ,Child B ,Child C . And serum CHE reached statistical significance （ P 〈0.05） ,when preoperative hepatic function grade was Child B , postoperative hepatic function grade was Child B ,Child C. However preoperative hepatic function grade was Child A ,Child B or Child C , if postoperative hepatic function grade was Child C , serum CHE didn＇t reach statistical significance （ P 〈0.05）. Serum CHE reached statistical significance （ P 〈 0.05） ,between the Group of the patients with complications of ascites,jaundice or hepatic encephalopathy and group of the patients without any complications. There were 5 patients with hepatic encephalopathy postopera tively in the 66 patients undergoing pericardial devascularization , 1 patient died , and preoperative serum CHE was all lower than 1 900 U/I.. [Conclusion]Serum CHE changes with the severity of cirrhotic liver, It can be one of the methods to evaluate the reserve function of cirrhotic liver, Using serum CHE to evaluate hepatic reserve function can make up of Child grade .