急性重症胆管炎患者早期血清胆碱酯酶活性检测的意义

Significance of serum cholinesterase activity in patients with severe acute cholangitis in early stage

目的探讨急性重症胆管炎患者早期血清胆碱酯酶活性检测的意义。方法选择32例急性重症胆管炎患者作为病例组(S组),其中25例预后良好,7例预后不良。收集S组入院时血清胆碱酯酶(ChE)、白细胞计数(WBC)、中性粒细胞百分比(Neu%)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBIL)和直接胆红素(DBIL),同时进行急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分,以同期30例体检健康者作为对照组(C组),收集C组上述实验室检查指标,比较组间、组内指标差异。结果 S组血清ChE和ALB明显低于C组(P<0.01),WBC、Neu%、PCT、ALT、AST、TBIL和DBIL显著高于C组(P<0.01);S组ChE与ALB呈正相关(r=0.893),与WBC、PCT、ALT、TBIL、DBIL、APACHEⅡ评分呈负相关(r=-0.591、-0.396、-0.493、-0.411、-0.392、-0.643),与Neu%和AST无明显相关(r=-0.320、-0.335);预后良好组ChE和ALB明显高于预后不良组(P<0.01),WBC、Neu%、PCT、TBIL、DBIL和APACHE II显著低于预后不良组(P<0.05或0.01),ALT和AST则较预后不良组无明显差别(P>0.05)。结论急性重症胆管炎患者早期ChE活性检测作为一项反映肝脏合成功能的有用指标,其活性降低可能与机体炎症反应相关,对病情的严重度和预后有一定的提示意义。

[Objective] To study the significance of serum cholinesterase activity in patients with severe acute cholangitis in early stage. [Methods] 32 acute eholangitis of severe type patients were chosen as case group （group S）. Among the group S, the prognoses of 25 patients were favorable, and others were unfavorable. Control group （group C） consisted of 30 healthy persons. The levels of serum cholinesterase （ChE）, white blood eount （WBC）, neutrophil （Neu%）, procalcitionin （PCT）, alanine aminotransferase （ALT）, aspartate transaminase （AST）, albumin （ALB）, total bilirubin （TBIL） and direct bilirubin （DBIL） were detected. In addition, the acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） score of group S was observed. Their correla- tion was analyzed. [Results] The levels of serum ChE and ALB in group S were significantly lower than group C （P〈0.01）, meanwhile the WBC, Neu%, PCT, ALT, AST, TBIL and DBIL had significantly higher than group C （P〈0.O1）. The ChE was positively related to ALB, negatively related to WBC, PCT, ALT, TBIL, DBIL and APACHE Ⅱ （correlation coefficient r were 0.893, -0.591, -0.396, -0.493, -0.411, -0.392, -0.643）, but appeared to be uncorrelated with Neu% and AST （r were -0.320, -0.335） in group S. The levels of ChE, ALB, WBC, Neu%, PCT, TBIL, DBIL and APACHE Ⅱ had significant differences between group unfavorable prognosis and favorable prognosis （P〈0.01 or 0.05）, but ALT and AST had no marked difference between the two groups （P 〉0.05）. [Conclusion] In the early stage of acute cholangitis of severe type, the level of serum ChE was associated with hepatic synthetic function and inflammatory response, furthermore, it could be used to predict the severity and prognosis of disease to some degree.