前白蛋白变化率对肝衰竭预后的预测作用

Prediction of prealbumin rate for liver failure patients′ prognosis

目的探讨血清前白蛋白(PALB)变化率与肝衰竭预后的关系。方法回顾性分析98例肝衰竭患者的临床资料,对患者进行Child-Pugh分级,并把患者分为好转组与未愈组,收集住院期间初始及末次PALB及其他主要肝功能指标的数值,并计算出PALB及其他主要肝功能指标的变化率。结果入院时患者的初始PALB数值明显下降,且Child-Pugh分级越高,数值越低。好转组与未愈组患者的初始PALB数值相近,当血清PALB数值快速升高时,好转组人数明显多于未愈组;当数值下降时,好转组人数明显少于未愈组;当数值升高不明显时,未愈组与好转组差异无统计学意义,但未愈组人数要多于好转组。PALB变化率的敏感度最高,特异度较总胆红素、凝血酶原活动度、国际标准化比值变化率低,而ROC曲线下面积最大。结论肝衰竭患者初始PALB明显比正常值低,而且病情越重,血清中PALB数值越低,但患者预后与初始PALB无相关性,而与PALB变化率相关。大部分PALB快速升高者,预后好;大部分PALB下降或升高缓慢者,预后差。而且PALB变化率对于预后的预测价值要高于其他主要肝功能指标。

Objective To explore the relationship between the prealbumin （PALB） rate and the prognosis of liver failure patients. Methods The clinical datas of 98 liver failure patients were retrospectively analyzed. We collected the patients＇ ChildPugh scores, and divided the patients into better group and worse group according to their prognosis. We also collected the values of PALB and other major liver function indexs after admission and the last time before discharge, and calculated the rate of PALB and other major liver function indexs. Results The initial PALB decreased significantly, and the higher of Child-Pugh classifi- cation, the lower of PALB. Between two prognosis, the initial PALB were similar. When the serum PALB increased rapidly, the cases of better group were significantly more than worse group. When it decreased, the cases of better group were obviously less than worse group. When it increased slowly, there was no statistical difference between the two groups, but the cases of worse group were still more than better group. The PALB rate＇s sensitivity was the highest, the specificity was lower than TBIL, PTA and INR, and the area under the ROC curve was the largest. Conclusions The initial value of liver failure patient＇s serum PALB is lower than normal, and the more serious of illness, the lower of PALB. But the prognosis is not correlated with initial PALB but correlated with PALB rate. Most patients whose PALB increases rapidly have good prognosis. Most patients whose PALB decrease or increase slowly have poor prognosis. And the prediction of PALB rate is better than other major liver function indexs.