血清缺血修饰性白蛋白评价不同病因肝硬化患者肝功能的意义

Significance of serum ischemia-modified albumin level in evaluating liver function in patients with liver cirrhosis of various causes

目的观察血清缺血修饰性白蛋白(IMA)、IMA/血清白蛋白(Alb)比值(IMAR)在不同病因肝硬化患者中的差异,探讨IMA、IMAR在评估肝功能方面的价值。方法收集2012年2月-2014年2月吉林大学中日联谊医院收治的456例肝硬化患者的病历资料。根据血清Alb水平分为Alb正常组152例、Alb降低组304例,根据病因进一步分为乙型肝炎、丙型肝炎和酒精性肝硬化组,以160例健康人群作为对照组。检测所有肝硬化患者IMA水平,计算IMAR,分析IMA、IMAR与肝功能指标和Child-Pugh评分的相关性。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较采用χ2检验;采用Spearman秩相关分析IMA、IMAR与Child-Pugh评分的相关性。结果与健康组比较,肝硬化患者IMA、IMAR明显升高(P值均<0.05),其中合并低白蛋白血症肝硬化患者IMA、IMAR明显高于未合并低白蛋白血症肝硬化患者(P值均<0.01)。此外,酒精性肝硬化患者IMA水平、IMAR明显高于乙型肝炎、丙型肝炎肝硬化患者(F值分别为6.765、8.276,P值均<0.01)。IMA与Alb、TBil、国际标准化比值(INR)和胆碱酯酶(Ch E)有一定相关性(r值分别为-0.510、0.731、0.327、-0.679,P值均<0.05)。IMAR与TBil、INR和Ch E有一定相关(r值分别为0.488、0.327、-0.896,P值均<0.05)。IMA、IMAR与Child-Pugh评分呈正相关(r值分别为0.801、0.899,P值均<0.05)。结论肝硬化患者在尚未合并低白蛋白血症前,Alb功能已经出现减退,且不同病因肝硬化患者IMA、IMAR存在明显差异。IMA检测能有效评估肝脏合成Alb的能力,可作为Child-Pugh分级和肝功能评价的辅助指标。

Objective To investigate the differences in serum levels of ischemia- modified albumin（ IMA） and IMA / albumin ratio（ IMAR） in patients with liver cirrhosis of various causes,as well as the significance of IMA measurement and IMAR in evaluating liver function. Methods A total of 456 patients with liver cirrhosis who were admitted to China- Japan Union Hospital of Jilin University from February 2012 to February 2014 were enrolled. The patients underwent liver function evaluation,and according to the serum albumin（ Alb） level,they were divided into normal Alb group（ 152 patients） and reduced Alb group（ 304 patients）. According to the cause of the disease,the patients were further divided into hepatitis B virus（ HBV） group,hepatitis C virus（ HCV） group,and alcoholic cirrhosis group,and healthy subjects were enrolled as controls. The serum IMA level was measured for all patients with liver cirrhosis,IMAR was calculated,and the correlations of IMA and IMAR with liver function parameters and Child- Pugh score were analyzed. An analysis of variance was used for comparison of coutinuous data between groups,and the least significant difference t- test was used for further comparision between any two groups; the chi- square test was used for comparison of categorical data between group and the Spearman rank correlation was used to analyze the correlation of IMA、IMAR、Child- Puch score. Results Compared with the healthy controls,the patients with liver cirrhosis showed significant increases in the serum IMA level and IMAR（ all P〈0. 05）,and the cirrhotic patients with hypoproteinemia had significantly higher serum IMA level and IMAR than those without hypoproteinemia（ all P〈0. 05）. In addition,the patients with alcoholic cirrhosis had significantly higher serum IMA level and IMAR than those with HBV- or HCV- associated liver cirrhosis（ F = 6. 765,8. 276; P〈0. 01）.The serum IMA level was correlated with Alb,total bilirubin（ TBil）,international normalized ratio（ INR）,and cholinesterase（ CHE）（ r =- 0. 510,0. 731,0. 327,- 0. 679; all P〈0. 05）. IMAR was correlated with TBil,INR,and CHE（ r = 0. 488,0. 327,- 0. 896; all P〈0. 05）. The serum IMA level and IMAR were positively correlated with Child- Pugh score（ r =- 0. 801,0. 899; all P〈0. 05）. Conclusion Patients with liver cirrhosis experience a reduced Alb function before the development of hypoproteinemia,and serum IMA level and IMAR differ significantly between the patients with liver cirrhosis of various causes.