肝肾综合征与血氨水平的关系

Analysis of the relationship between hepatorenal syndrome and plasma ammonia

目的 分析肝硬化患者肝肾综合征（HRS）的患病率，研究HRS患者血氨水平与肾功能的关系，探讨HRS在肝性脑病发生和发展中的作用。方法收集我院2007年1月-2009年3月465例肝硬化患者以及2009年3月80例单纯肾功能障碍患者、80例健康体检者的血清和血浆，检测其肝功能（ALT、AST、Y-谷氨酰转肽酶、总胆红素、血清总蛋白、白蛋白）、肾功能（尿素氮、肌酐）指标和血氨。分别以尿素氮和肌酐为诊断标准，比较两种诊断标准的HRS患病率；分析HRS组与非HRS组及单纯肾功能障碍组之间血氨水平的差异；并对40例HRS患者肾功能指标与血氨水平的相关性进行追踪分析。结果以尿素氮为诊断标准的HRS患病率为39．6％，明显高于以肌酐为标准的17．舭（x^2=97．33，P〈0．01）；以尿素氮和肌酐为标准的HRS组血氨水平分别为（57．39±48．83）μmol／L和（64．80±47．25）μmol／L，明显高于非HRS组的（47．58±36．28）μmol／L和（46．13±29．99）μmol／L（t值分别为-3．07和3．67，P值均〈0．01）；单纯肾功能障碍组血氨水平为（26．59±14．34）μmol／L，明显低于肝硬化HRS组和非HRS组（P值均〈0．01），但与健康对照者组的（22．36±8．72）μmol／L比较，差异没有统计学意义（t=1．52，JD〉0．05）。HRS组追踪分析发现，血氨水平与尿素氮和肌酐呈正相关关系，相关系数分别为0．874和0．834（P值均〈0．05）。结论肝性脑病实质是肝肾肠脑综合征。肝肾综合征影响血氨水平，从而促进了肝性脑病的发生和发展。

Objective To analyze the relationship between hepatorenal syndrome （HRS） and plasma ammonia. Methods Plasma ammonia, liver and renal function of 465 patients with liver cirrhosis in our hospital, from June 2007 to March 2009, were analyzed. 80 renal dysfunction patients and 80 healthy controls were recruited in the control group. In addition, 40 patients with HRS were followed up. Results Using urea as the diagnosis standard of HRS, the morbidity rate of HRS was 39.6%, which was higher than that using creatinine as the diagnosis standard ofHRS （ x^2 = 97.33, P 〈 0.01）. using urea and creatinine as the diagnosis standard of HRS, the ammonia level of HRS groups was （57.39 ±48.83）μmol/L, （64.80 ±47.25）μmol/L, which were higher than that in the non-HRS groups （t = -3.07, t = -3.67, P 〈 0.01）. The ammonia level of patients with renal dysfunction was （26.59 ± 14.34） μmol/L, which was lower than that in HRS group, non- HRS group （P 〈 0.01）, but there was no statistical significance between the patients with renal dysfunction and the healthy peoples [（22.36 ± 8.72） μmol/L] （t = 1.52, P 〉 0.05）. The followed-up analysis of 40 patients with HRS indicated that plasma ammonia level was positively correlated with urea and creatinine, and correlation coefficients were 0.874 and 0.834 （P 〈 0.05）. Conclusion Hepatic encephalopathy is liver-kidneyintestine-brain syndrome. HRS plays an important role in the development of hepatic encephalopathy.