肝硬化Child-Pugh评分的相关因素分析

Studies on relevant gactors of Child-Pugh grading in hepatic cirrhosis

目的探讨肝硬化患者Child-Pugh评分与肝脏合成功能[胆碱酯酶(ChE)、凝血酶原时间(PT)]、肾功能[血清胱抑素(CysC)、肌酐(Cr)、尿素氮(BUN)]、血清钙和磷水平的相关性。方法回顾性分析179例肝硬化患者的Child-Pugh分级及肝肾功能、血清钙、磷水平的关系,按Child分级分为A、B、C三组,Child不同分级间生化指标的比较采用方差分析和S-N-K检验。Child评分与各生化指标间的相关性采用双侧Pearson相关分析,各生化指标对Child评分的影响作用采用多元回归分析方法。结果随着Child评分的升高,肝硬化患者的ChE下降、PT升高,A、B、C三组间差异具有统计学意义(P<0.05);BUN、Cr呈升高趋势,A、C两组间具有统计学差异(P<0.05);B、C组间BUN差异有统计学意义(P<0.05)。Child分级A、B、C三组肝硬化患者的Cys、钙、磷无明显变化。相关分析显示,Child评分与年龄、PT、BUN、Cr正相关,与ChE呈负相关(P<0.05)。多元回归分析显示,ChE、PT对于Child评分有明显影响作用。结论肝硬化不同Child-Pugh分级中ChE、PT、Cr、BUN出现明显变化。其中,血清ChE对于Child评分有明显的影响作用,是判断肝脏疾病严重程度的重要参考依据。

Objective To investigate the correlation of Cholinesterase（ChE）,prothrombin time（PT）,Serum Cystatin C（CysC）,serum creatinine（Cr）,blood urea nitrogen（BUN）,serum calcium（Ca2＋） and serum phosphorus（P） with different Child-Pugh classification in hepatic cirrhosis patients.Methods In 179 hepatic cirrhosis patients with different Child-Pugh classification,serum ChE,PT,CysC,Cr,BUN,Ca2＋ and P were retrospectively analyzed.And their clinical significance was appraised with Pearson correlation analysis and Multinomial logistic regression analysis.Results erum ChE and Ca2＋remarkablely declined and PT increased with increases grading of Child-pugh classification（P0.05）;CysC and Cr increased gradually having a significant difference between Child A group vs Child C group（P0.05）;Bun increased gradually with a significant difference between the two groups Child A group vs Child C group and Child B group vs Child C group（P0.05）.There was no difference in P in all groups.Pearson correlation analysis showed that age,PT,BUN and Cr were positively correlated with Child-Pugh grading,and that ChE was negatively correlated with it.Multinomial logistic regression analysis showed that factors influencing Child-Pugh included CHE and PT.Conclusions Serum ChE,CysC,BUN,Cr and Ca2＋ changed with different Child-Pugh classification.Serum ChE had important guiding value on the clinical assessment of liver disease severity.