血清总胆红素/谷氨酰转移酶比值对判断肝硬化预后的意义

The application of ratio of serum total bilirubin to glutamyltransferase in prognostic judgement of liver cirrhosis patients

目的寻找肝硬化预后评价指标。方法对2001年1月至2004年9月间收治的62例肝硬化住院病人进行随访。内容包括出院时血清总胆红素(TB)、谷氨酰转移酶(GGT)、血清TB/GGT比值、凝血酶原时间(PT)及INR、血清白蛋白和肌酐水平、腹水程度及肝性脑病等。分别计算Child-Pugh积分和分级、MELD计分和TB/GGT比值,MELD计分按分值分为A(<10分)、B(10-18分)、C(>18分)三个等级;TB/GGT比值分为A(<0.5)、B(0.5-1.5)、C(>1.5)三个等级。随访至2005年9月底,终点事件为肝病死亡。结果 62例病人随访期间27例因肝病死亡,随访时间1-54个月。TB/GGT比值等级与Child分级、MELD评分等级在全部病人和死亡病例中等级分布无差异,各时点病死率亦无差异。3个月和1年累积病死率(95%可信限)分别为6.90%(1.0-32.0%)、23.81%(8.0%-47.0%)、41.76%(15.0%-72.0%)和13.79%(4.0%-32.0%)、38.10%(22.0%-66.0%)、58.33%(38.0-85.0%)。结论 TB/GGT比值可作为判断肝硬化预后的简易指标。

Objective To find a index of prognostic judgement in liver cirrhosis patients.Methods 62 inpatients with viral liver cirrhosis were followed up during January 2001 to September 2004.Serum total bilirubin,glutamyltransferase,the ratio of serum total bilirubin to glutamyl-transferase（TB/GGT）,prothrombin time（PT）,INR,serum albumin and creatinine,degree of ascite and hepatoencephalopathy were included.At the sametime the score of Child-Pugh,MELD and ratio of TB/GGT were calculated respectively.The grade of MELD was ranked by A（〈10）,B（10-18）,C（〉18）;the grade of TB/GGT by A（〈0.5）、B（0.5-1.5）、C（1.5）;and the score of Child-Pugh was ranked by A,B,C.The patients were followed up to September 2005 and the final event was died by cirrhosis.Results 27 of 62 patients died during follow up periods（1-54 months）.There were no difference statistically among the grades of TB/GGT,Child-Pugh and MELD in total and dead patients,and so as the mortality at each time.The mortality（95%CI） of 3 months and one year were 6.90%（1.0-32.0%）,23.81%（8.0%-47.0%）,41.76%（15.0%-72.0%） and 13.79%（4.0%-32.0%）,38.10%（22.0%-66.0%）,58.33%（38.0-85.0%） respectively.Conclusion The ratio of TB/GGT may be a simple index in predicting the prognosis of viral liver cirrhosis.