血清球蛋白/胆碱酯酶与失代偿期肝硬化肝损伤程度及并发症的关系分析

Relationship between globulin/cholinesterase ratio, seveirty of liver injury and complications in patients with decompensated liver cirrhosis

目的探讨失代偿期肝硬化患者血清球蛋白/胆碱酯酶(G/C)与Child-Pugh分级、终末期肝病模型(MELD)评分及并发症发生情况的相关性。方法选取275例失代偿期肝硬化患者进行回顾性分析,根据入院时G/C将其分为0.5≤G/C≤1.0组、1.0<G/C≤2.0组及G/C> 2.0组,比较3组的Child-Pugh分级、MELD评分,以及随访6个月时的肝硬化常见并发症的发生情况。结果 (1) 0.5≤G/C≤1.0组Child-Pugh A级患者比例为98.5%,1.0<G/C≤2.0组ChildPugh B级患者比例为95.8%,G/C> 2.0组Child-Pugh C级患者比例为97.8%,3组Child-Pugh分级两两相比差异均有统计学意义(P均<0.017);G/C随Child-Pugh分级的上升而升高,两者呈正相关(rs=0.973)。(2) 0.5≤G/C≤1.0组MELD评分≤9患者比例较高(56.9%),1.0<G/C≤2.0组MELD评分主要集中在10~29分(95.5%),G/C> 2.0组MELD评分≥30分患者比例较高(86.8%),3组MELD评分比较差异均有统计学意义(P均<0.017);G/C随MELD评分的上升而升高,两者呈正相关(rs=0.879)。(3)随着G/C值上升,上消化道出血及自发性腹膜炎发生率增加,G/C> 2.0组出现并发症几率高于其他2组(P均<0.017),肝性脑病及电解质紊乱发生率3组比较无统计学差异(P均> 0.05)。结论 G/C与Child-Pugh分级及MELD评分有良好的相关性,且与常见并发症的发生有一定相关性,或可成为评估失代偿期肝硬化患者肝损伤程度及并发症发生率的辅助预测指标。

Objective To analyze the correlation between globulin/cholinesterase(G/C) ratio and Child-Pugh grade, Model for End-stage Liver Disease(MELD) score and the incidence of complications in patients with decompensated liver cirrhosis. Methods Clinical data of 275 patients with decompensated liver cirrhosis were retrospectively analyzed. All patients were divided into three groups according to G/C ratio at admission: 0.5 ≤ G/C ≤ 1.0, 1.0< G/C ≤ 2.0 and G/C >2.0 groups. Child-Pugh grade, MELD score and the incidence of common complications of liver cirrhosis at 6-month follow-up were statistically compared among three groups. Results In the 0.5 ≤ G/C ≤ 1.0 group, the proportion of patients with Child-Pugh A was as high as 98.5%, 95.8% in the 1.0< G/C ≤ 2.0 group and 97.8% in the G/C > 2.0 group. Statistical significance was observed in terms of the Child-Pugh grade between any two of the three groups(all P < 0.017). G/C ratio was positively correlated with the increase of Child-Pugh grade(rs = 0.973). In the 0.5 ≤ G/C ≤ 1.0 group, the percentage of patients with MELD score of ≤ 9 was 56.9%. In the 1.0< G/C ≤ 2.0 group, the percentage of patients with MELD score of 10-29 was 95.5%. The percentage of patients with MELD score of ≥ 30 was 86.8%in the G/C>2.0 group. Statistical significance was noted in the MELD scores among three groups(all P < 0.017).G/C ratio was positively associated with the increase of MELD score(rs = 0.879). With the increase of G/C ratio, the incidence of the upper gastrointestinal bleeding and spontaneous peritonitis was elevated. In the G/C>2.0 group, the incidence of complications was significantly higher compared with that in the other two groups(both P < 0.017). No statistical significance was observed in the incidence of hepatic encephalopathy and electrolyte disorder among three groups(both P > 0.05). Conclusions G/C ratio has good correlation with Child-Pugh grade and MELD score, and it has certain correlation with the incidence of common complications, which can be used as a predictive index to evaluate the degree of liver injury and the incidence of complications in patients with decompensated liver cirrhosis.