肝硬化合并门静脉高压介入治疗前后血清PA、CHE、AFP水平变化及临床意义

Changes of serum PA,CHE and AFP levels in patients with liver cirrhosis complicated with portal hypertension before and after interventional therapy and their clinical significance

目的探讨肝硬化合并门静脉高压介入治疗前后血清前白蛋白(PA)、胆碱酯酶(CHE)、甲胎蛋白(AFP)水平变化及临床意义。方法选取2017年2月~2018年12月四川大学华西医院收治的202例行介入治疗的肝硬化门静脉高压患者及200例健康体检者为研究对象,分别纳入肝硬化组及对照组。检测两组治疗前及肝硬化组治疗后血清PA、CHE、AFP水平及总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)等肝功能指标,分析血清PA、CHE、AFP水平对患者治疗效果及预后的预测价值。结果①与对照组比较,肝硬化组患者血清PA、CHE降低,AFP升高(P<0.05)。②与治疗前比较,治疗后肝硬化患者TBIL、ALT、AST等肝功能指标显著降低,血清PA、CHE水平升高,AFP降低(P<0.05)。③Pearson相关性分析显示,血清PA、CHE与TBIL、ALT、AST等肝功能指标呈负相关,血清AFP与肝功能指标呈正相关(均P<0.05)。④无效患者术前、术后PA、CHE水平显著低于有效患者,AFP显著高于有效患者(P<0.05);术前PA、CHE、AFP水平预测肝硬化门静脉高压患者治疗效果的曲线下面积为0.831、0.820、0.791,当截点值为92.61mg/L、2.97kU/L、7.44μg/L时约登指数最大。⑤以术后1年为随访终点,肝硬化组全因性死亡率为25.74%(52/202),死亡患者术前、术后血清PA、CHE水平显著低于存活者,AFP显著高于存活者(P<0.05)。Logistic多因素分析显示,在矫正其他因素后,术前血清PA、CHE、AFP水平是肝硬化门静脉高压患者预后的独立影响因素。结论肝硬化门静脉高压患者伴有血清PA、CHE的降低及AFP的升高,在介入治疗后各指标明显改善,这些指标可辅助用于预后的预测,为介入术后后续治疗提供重要参考依据。

Objective To investigate the changes of serum prealbumin(PA),cholinesterase(CHE)and alpha-fetoprotein(AFP)levels in patients with liver cirrhosis complicated with portal hypertension before and after interventional therapy and their clinical significance.Methods 202 patients with liver cirrhosis and portal hypertension underwent interventional therapy and 200 healthy subjects received physical examination in West China Hospital of Sichuan University from February 2017 to December 2018 were selected as the research subjects,and they were included in the liver cirrhosis group and the control group,respectively.Serum PA,CHE and AFP levels and liver function indicators such as total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in both groups were detected before and after treatment.The predictive value of serum PA,CHE and AFP levels for the prognosis was analyzed.Results Compared with the control group,serum PA and CHE were lower,and AFP was higher in the liver cirrhosis group(P<0.05).After treatment,liver function indexes such as TBIL,ALT and AST in the liver cirrhosis group were significantly reduced(P<0.05),serum PA and CHE levels were increased,and AFP was decreased(P<0.05).Pearson correlation analysis showed that serum PA and CHE were negatively correlated with liver function indexes such as TBIL,ALT and AST(P<0.05),and serum AFP was positively correlated with liver function indexes(P<0.05).The levels of PA and CHE in ineffective patients were significantly lower than those in the effective patients,and the AFP was significantly higher than that in the effective patients.The difference was statistically significant(P<0.05).The area under the curve of treatment effect was 0.831,0.820,0.791,and the Jordanian index was the highest when the cut-off values were 92.61 mg/L,2.97 kU/L,7.44μg/L.Taking 1 year after operation as the end point of follow-up,the all-cause mortality rate of the liver cirrhosis group was 25.74%.The serum PA and CHE levels in the death group were significantly lower than those in the survival group,and the AFP was significantly higher than that in the survival group before and after operation(P<0.05).Logistic multivariate analysis showed that after correction of other factors,preoperative serum PA,CHE,and AFP levels were independent factors affecting prognosis in patients with portal hypertension of cirrhosis.Conclusion Patients with liver cirrhosis and portal hypertension have decreased serum PA and CHE and elevated AFP.After interventional therapy,all indicators are improved significantly.The indicators can be used to predict the prognosis,thus providing reference for the follow-up treatment after interventional operation.