白蛋白－胆红素指数与血氨联合检测对肝硬化并发肝性脑病的诊断价值评估

Diagnostic value of albumin-bilirubin grade combined with serum ammonia in cirrhosis with hepatic encephalopathy

目的探讨白蛋白－胆红素指数（ALBI）联合血氨对肝硬化并肝性脑病诊断的价值。方法选择2015年1月至2017年1月北京佑安医院收治的139例肝硬化患者，包括73例无肝性脑病患者和66例伴有肝性脑病患者。对所有患者进行白蛋白、胆红素和血氨等指标检测。分析ALBI、血氨值与肝性脑病分级和肝硬化患者Child分级之间的关系。结果ALBI值和血氨值随着Child分级的升高而增高，ALBI值在Child A、B、C级的值分别为－2.3±0.6、－1.7±0.5、－0.9±0.4，差异有统计学意义（F＝125.100，P〈0.001）。血氨值在Child A、B、C级的值分别是（42.6±16.0）、（56.1±31.2）、（69.8±34.7）μmol/L，差异有统计学意义（F＝7.400，P〈0.001）。ALBI值随着终末期肝病模型（MELD）评分的升高而升高，呈正相关（r＝0.547，P〈0.001）。血氨和ALBI值在伴有肝性脑病组分别为（83.6±39.5）μmol/L、－1.1±0.5，高于不伴有肝性脑病组的（42.9±17.0）μmol/L、－1.6±0.7，差异均有统计学意义（t＝8.130、5.244，均P〈0.001）。ALBI与血氨联合检测肝性脑病时，ROC曲线下面积为0.911，诊断肝性脑病的敏感度为93.9%，特异度为93.2%。结论ALBI与血氨联合检测诊断肝性脑病的诊断效能较高，具有较高的临床应用价值。

ObjectiveTo explore the value of albumin-bilirubin （ALBI） grade combined with serum ammonia in the diagnosis of cirrhosis with hepatic encephalopathy （HE）.MethodsThe serum level of total bilirubin（TBIL）, albumin（ ALB ）and blood ammonia were detected in 139 patients including 73 cirrhosis patients without HE and 66 cirrhosis patients with HE from January 2015 to January 2017 in Beijing You′an Hospital, and the relationship between ALBI and blood ammonia value and Child grade and hepatic encephalopathy was analyzed.ResultsThe level of ALBI and blood ammonia were more and more higher with the increase of Child grade, the level of ALBI in Child A, B and C were -2.3±0.6, -1.7±0.5, -0.9±0.4, and there was a statistically significant（F=125.100, P〈0.001）. The blood ammonia concentration in Child A, B and C were（42.6±16.0）, （56.1±31.2）, （69.8±34.7） μmol/L, and there was a statistically significant（F=7.400, P〈0.001）. The level of ALBI was higher with the increase of model for end-stage liver disease （MELD） grade, and there was a positive correlation（r=0.547, P〈0.001）. The ALBI value in the HE group was higher than the cirrhosis patients without HE（（-1.1±0.5）vs（-1.6±0.7））, and the difference was statistically significant （t=5.244, P〈0.001）. Level of blood ammonia in the HE group was（83.6±39.5）μmol/L, which was higher than the level of cirrhosis patients without HE（42.9±17.0）μmol/L, and the difference was statistically significant （t=8.130, P〈0.001） . When ALBI and blood ammonia were combined, the ROC curve area was 0.911, the sensitivity was 93.9%, the specificity was 93.2%.ConclusionThere is a significant diagnosis value and high clinical application when ALBI is combined with blood ammonia to diagnose HE .