肝硬化患者血清总胆汁酸和γ球蛋白的检测及其临床意义

Clinical significance of plasma total bile acid and gamma globulin in patients with hepatic cirrhosis

目的:探讨肝硬化患者的血清总胆汁酸 (TBA)和γ球蛋白的检测及其临床意义。 方法 :测定 49例肝硬化患者和 34例非肝病患者的血清 TBA及γ球蛋白水平 ,并同时测定血清总胆红素 (TBi L )、白蛋白 (AL B)、谷丙转氨酶 (SGPT)、谷草转氨酶 (SGOT)、γ谷氨酰转肽酶 (γ- GT)及碱性磷酸酶 (AKP)水平。 结果:肝硬化组血清TBA及γ球蛋白水平均显著高于非肝病组 (P <0 .0 1) ;TBA在 Child- Pugh C级中最高 ,与 A级和 B级相比有显著性差异 (P <0 .0 5 ) ;γ球蛋白水平随 Child- Pugh分级升高而升高 ,各组间差异有显著性 (P <0 .0 1) ;与其他肝功能试验相比 ,TBA敏感性优于 TBi L、γ- GT和 AKP(P <0 .0 5 ) ;γ球蛋白敏感性优于 AL B(P <0 .0 1)。 结论 :TBA、γ球蛋白能敏感地反映肝功能损害的程度 ,联合检测有助于病情和预后的早期判断。

Objective: To study the levels of plasma total bile acid(TBA) and gamma globulin and to assess their clinical significance. Methods: The plasma levels of TBA and gamma globulin were measured in 49 patients with hepatic cirrhosis and 34 patients with non-hepatic diseases. At the same time, the other indexes of liver function were also detected including serum total bilirubin (TBiL) , albumin (ALB), aspartate aminotransferase(SGPT), alanine aminotransferase(SGOT), gamma glutamyl transpeptidase (γ-GT) and alkaline phosphate (AKP). Results: The levels of plasma TBA and gamma globulin were significantly higher in patients with hepatic cirrhosis than those with non-hepatic diseases (P<0.01). According to the Child-Pugh classification,the level of plasma TBA was the highest in Child-Pugh C grade and was significantly different between Child-Pugh C grade and Child-Pugh A grade as well as Child-Pugh B grade (P<0.05).The higher the liver function of Child-Pugh grade, the higher the gamma globulin rise (P<0.01). In comparison with the other liver function tests, the sensitivity of TBA was better than TBiL, γ-GT and AKP (P<0.05) and the sensitivity of gamma globulin was better than ALB (P< 0.01). Conclusion: The levels of plasma TBA and gamma globulin are closely associated with the severity of hepatic cirrhosis and are helpful for confirming state of the illness and reflecting prognosis.