前白蛋白、总胆汁酸、凝血酶原活动度及胆固醇检测对肝功能分期及判断预后的临床意义

The clinical significance of the levels of serum prealbumin,total bile acid,prothrombin activity,and cholesterol for the grading of liver function and prognosis

目的探讨血清前白蛋白、总胆汁酸、胆固醇、凝血酶原活动度对肝功能分级及判断预后的意义。方法将慢性肝病患者108例,根据Child-Pugh改良分级法分为Child A级组(53例),Child B级组(30例)及ChildC级组(25例)。选取健康体检者24例作为对照。分别取肘静脉血做血清总蛋白、白蛋白、总胆红素、前白蛋白、总胆汁酸、胆固醇及凝血酶原活动度测定,并进行腹部彩超检查了解肝、脾、门静脉宽度及腹水情况。结果①ChildA、B、C三组血清白蛋白平均值为35.9mg/L、29.1mg/L和26mg/L,前白蛋白为207mg/L、110.2mg/L和76.2mg/L,胆固醇为4.5nmol/L、3.6nmol/L和2.3nmol/L,较对照组明显下降(P<0.05);②Child A、B、C三组总胆汁酸水平分别为13.4μmol/L、31.5μmol/L和58.53μmol/L,组间比较有显著性差异(P<0.05);③凝血酶原时间三组分别为14.5s、15.7s和20.2s。而凝血酶原活动度为84.1%、62%和37.7%,组间比较有显著性差异(P<0.05)。④ChildC组死亡的6例中,血清前白蛋白<100mg/L,总胆汁酸>30μmol/L,胆固醇<2.5mmol/L,凝血酶原活动度<40%。结论除血清白蛋白符合Child-Pugh改良分级法外,凝血酶原时间及血清胆红素水平对分级意义不大。而前白蛋白、总胆汁酸、胆固醇及凝血酶原活动度对肝功能的分级及判断预后更具客观意义。

Objective To establish objective criteria for the grading of liver function and prognosis through analyses of serum albumin, prealbumin,total bile acid, cholesterol, prothrombin time and prothrombin activity. Methods 108 patients with chronic hepatopathy were divided into 3 groups according to the modified Child - Pugh classification （group Child A,Child B and Child C）. There were 24 patients in the control group. Blood from the median eubital vein was taken for detecting the levels of total serum protein, albumin, prealbumin, total bilirubin, total bile acid, cholesterol, and prothrombin activity. Abdominal sonography was performed to examine the liver, spleen,the width of portal vein＇s width, and aseites. Results ①In group Child A,Child B and Child C,the average serum albumin levels were 35.9,29. land 26mg/L respectively. Prealbumin level ：207,110.2 and 76.2mg/L ; Cholesterol ： 4.5,3.6 and 2.3nmoL/L. These values were significantly lower （ P 〈 0.05 ） compared with the control group. ②The total bile acid level in group Child A, Child B and Child C were 13.4,31.5 and 58.53μmol/L respectively,which had no statistical difference among the three groups. ③The prothrombin time in the three groups were 14.5,15.7 and 20.2s, and there was no statistical difference between group Child A and Child B. However, significant difference （ P 〈 0.05 ） were found for the prothrombin activities among the three groups （84.1% , 62% and 37.7% ）. ④For the six patients in Group Child C who finally died,serum prealbumin was 〈 100mg/ L, total bile acid 〉 30μmol/L, cholesterol 〈 2.5mmoL/L and prothrombin activity was 〈 40%. Conclusion The serum albumin is in accordance with the modified Child - Pugh classification, while the prothrombin time and serum bilirubin have little significance for grading. The serum prealbumin, total bile acid, cholesterol, and prothrombin activity are the more objective criteria for the grading of liver function and prognosis.