总胆汁酸及前白蛋白等指标诊断肝硬化及肝肿瘤的应用价值

Clinical significance of determination of serum total bile acids and prealbumin in patients with liver cirrhosis and hepatic tumor

目的调查血清总胆汁酸（TBA）等指标在肝硬化及肝肿瘤患者中的水平，讨论其临床应用价值。方法163例分为三组：肝硬化代偿组56例，肝硬化失代偿组62例，肝肿瘤组45例；对照组51例，为心、肺、肝、肾功能均无异常的健康体检者。所有受试者均空腹抽血检测以下指标：血清总胆汁酸（TBA）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、胆红素、前白蛋白（PA）、白蛋白（ALB）、胆碱脂酶活性（CHE）、总蛋白（TP）、超敏C反应蛋白（Hs—CRP）、补体C3。比较患者组与健康体检者化验指标的差异。结果（1）疾病组血清总胆汁酸（TBA）均显著升高（P〈0．01），失代偿组水平最高。（2）转氨酶均升高（P〈0．01），代偿组以谷丙转氨酶（ALT）升高显著；而另两组以谷草转氨酶（Asr）升高更为明显。（3）前白蛋白（PA）均下降（P〈0．01），三组间无显著性差异（P〉0．05）。白蛋白（ALB）、胆碱脂酶活性（CHE）的水平按代偿组、失代偿组、肝肿瘤组依次降低（相邻两组间P〈0．05）。（4）肝硬化失代偿前后补体C3水平均显著下降（P〈0．01），失代偿组下降更为明显。结论在肝硬化、肝肿瘤患者中，血清总胆汁酸（TBA）的检测较其他指标更为敏感。前白蛋白（PA）更为敏感地反映肝脏合成功能的损害程度。补体C3的改变与肝硬化病情密切相关。HS—CRP与病情进展高度相关，尽早控制炎症有利于疾病的治疗。总胆汁酸（TBA）等指标的联合检测有利于对病情的分析和诊治。

Objective To investigate the clinical value of serum total bile acids （TBA） ,prealbumin and other indicators in the patients with liver cirrhosis and hepatic tumor. Methods The data of the patients and normal controls were collected.Results （ 1）The levels of TBA in all patients were increased（ P 〈 0.01）. The level of TBA in the decompensated hepatic cirrhosis group was highest. There were no significant differences between compensated hepatic cirrhosis group and liver cancer group（ P 〉0.05）. （2）In the patients with compensated hepatic cirrhosis,the level of ALT was significantly higher than the level of AST. On the other hand,the level of AST was significantly higher than the level of ALT in the patients with decompensated hepatic cirrhosis and fiver tumor. With increasing fiver injury, the levels of TBA, BILIT and BILID were significantly increased. （3） The levels of PA in the three groups were especially lower（ P 〈 0.01 ） ; there was no significant difference between the three groups（ P 〉 0.05）.The levels of ALB and CHE were markedly lowered in the following order：compensated hepatic cirrhosis group 〉 decompensated hepatic cirrhosis group 〉 hepatic tumor group. The level of HS - CRP was increased in the same order. The levels of TP was lowered（ P 〈 0.05 or P 〈 0.01 ）. （4） In the patients with hepatic cirrhosis, the the level of complement C3 was significantly decreased（ P 〈 0.01）. The level of complement C3 in decompensated hepatic citrlaosis group was much lower than the level in compensated hepatic cirrhosis group. Conclusions The determination of level of serum TBA is more sensetive to reflect the damage of fiver earlier. The level of PA is more sensitive to indicate anabolic function. The change in levels of complement C3 has close relationship with hepatic cirrhosis. The high levels of CRP indicate that there is a close relationship between the development of diseases and inflammation. Combined determination of the levels of TBA,PA etc is beneficial to diagnosis and treatment of fiver cirhosis and hepatic tumor.