肝损伤患者血清肝活素水平测定的临床意义

Determination of serum hepassocin levels in liver injury patients and its clinical significance

目的探究肝活素(HPS)在阻塞性黄疸所致肝损伤的诊断以及慢性肝病肝功能评估中的作用。方法 ELISA法检测60例阻塞性黄疸患者、68例慢性肝病患者及30例健康体检者血清HPS水平。分析肝损伤患者与正常人血清HPS水平有无差异;对阻塞性黄疸患者血清HPS和丙氨酸氨基转移酶(ALT)进行相关性分析;绘制受试者工作特征曲线,观察HPS对阻塞性黄疸所致肝损伤的诊断价值;分析慢性肝病患者HPS与Child-Pugh分级(CPC)以及肝衰竭之间的关系。结果阻塞性黄疸和慢性肝病患者血清HPS水平均显著高于对照组(P<0.01)。阻塞性黄疸患者血清中HPS与ALT呈正相关性(rs=0.914,P<0.01);HPS在阻塞性黄疸肝损伤诊断中的曲线下面积达到0.938,最佳节点是141.87μg/L;慢性肝病中非衰竭者Child A、Child B、Child C与慢加急性肝衰竭、慢性肝衰竭5组之间两两比较,非肝衰竭组中,随着CPC升高,HPS水平也逐渐升高(P<0.05),两组肝衰竭血清HPS水平均高于非衰竭各组(P<0.05),两组肝衰竭之间HPS水平差异无统计学意义。结论血清HPS水平测定能够对阻塞性黄疸患者有无肝损伤作出诊断,也能够辅助CPC评估慢性肝病患者肝功能。

Objective To investigate the effect of hepassocin（ HPS） in diagnosis of liver injury caused by obstructive jaundice and the assessment of liver functionin chronic liver disease.Methods Serum levels of HPS in 60 obstructive jaundice patients,68 chronic liver disease patients and 30 healthy controls were determined by ELISA essay. The difference of serum HPS levels between liver injury patients and healthy control group were analyzed. The correlation between HPS and alanine aminotransferase（ ALT） in obstructive jaundice patients were analyzed. The diagnostic value of HPS to liver injury resulting from obstructive jaundice was described by receiver operating characteristic curve. The relations of HPS with Child-Pugh classification（ CPC） and liver failure in chronic liver disease were analyzed.Results The serum HPS levels in obstructive jaundice and chronic liver disease patients were significantly higher than that in healthy control group（ P〈0. 01）. Statistic analysis revealed a good positive correlation between HPS and ALT in obstructive jaundice patients（ rs= 0. 914,P 〈0. 01）. Area under curve of HPS achieves0. 938,the cut-off value of HPS as a diagnostic index of liver injury resulting from obstructive jaundice was 141. 87μg/L. Child A、B and C groups in chronic liver disease without liver failure along with acute-on-chronic liver failure and chronic liver failure groups were compared each two groups. Serum HPS levels gradually increased following the rise of CPC in patients without liver failure（ P〈0. 05）. Serum HPS levels in both two liver failure groups were significantly higher than that in each group without liver failure（ P〈0. 05）. Serum HPS levels between ACLF and CLF groups had no significant difference.Conclusion Serum HPS levels can be diagnosed with or without liver injury in patients with obstructive jaundice,and can also assist in the evaluation of liver function in patients with chronic liver disease conbined with CPC.