血清NGAL、Scr、TBil在慢性乙型肝炎肝硬化患者预后评估中的应用价值

The value of serum NGAL,Scr and TBil in prognosis evaluation of patients with chronic hepatitis B cirrhosis

目的:分析慢性乙型肝炎肝硬化(CHB-LC)患者血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肌酐(Scr)、总胆红素(TBil)水平,并探讨三者与CHB-LC病情严重程度及预后的关系。方法:选取2017年6月至2019年12月122例CHB-LC患者作为观察组,另选取100例同时期体检健康人群作为对照组,两组患者均进行血清NGAL、Scr、TBil以及AST、ALT、INR检测,并根据Child-Pugh分级分为A级、B级及C级,比较不同程度肝硬化患者上述指标表达变化。观察组患者均随访6个月,采用COX回归分析影响CHB-LC患者预后的因素,绘制受试者工作特征曲线(ROC)分析其对CHB-LC患者预后的评估价值。结果:观察组酗酒占比及AST、ALT、INR、Scr、TBil、NGAL水平高于对照组(P<0.05);与Child-Pugh A级相比,Child-Pugh B级、C级患者血清NGAL、Scr、TBil及AST、ALT、INR水平升高(P<0.05);且预后不良组患者上述指标及酗酒占比也明显高于预后良好组患者。COX回归分析显示,NGAL、Scr是影响CHB-LC患者预后的独立危险因素,其中血清Scr、NGAL及二者联合对CHB-LC患者预后的诊断价值均较高,AUC面积分别为0.798、0.821、0.908。结论:CHB-LC患者血清中Scr、TBil及AST、ALT、INR、NGAL水平均较高,且与肝功能分级及预后情况有一定的关系,Scr、NGAL是影响CHB-LC患者预后的危险因素,可作为预后预测指标。

Objective:To analyze the levels of serum neutrophil gelatinase associated lipocalin(NGAL),creatinine(Scr)and total bilirubin(TBil)in patients with chronic hepatitis B cirrhosis(CHB-LC),and to explore the relationship between the three levels and the severity and prognosis of CHB-LC.Methods:A total of 122 patients with CHB-LC from June 2017 to December 2019 were selected as the observation group,and 100 healthy people during the same period were selected as the control group,serum NGAL,Scr,TBil,AST,ALT and INR were detected in both groups,and were divided into Child A,Child B and Child C according to child Pugh classification,and compare the levels of NGAL,Scr,TBil and AST,ALT,INR in patients with different degrees of liver cirrhosis.The patients in this group were followed up for 6 months,Cox regression was used to analyze the prognostic factors of patients with CHB-LC,and receiver operating characteristic curve(ROC)was drawn to analyze the prognostic value of patients with CHB-LC.Results:The proportion of alcoholism and the levels of AST,ALT,INR,Scr,TBil and NGAL in the observation group were higher than those in the control group(P<0.05);compared with Child A,the serum NGAL,Scr,TBil,AST,ALT,INR levels in Child B and Child C patients were significantly higher(P<0.05),the above indexes and the proportion of alcoholism in poor prognosis group were also significantly higher than those in good prognosis group.COX regression analysis showed that NGAL and Scr were independent risk factors affecting the prognosis of CHB-LC patients.Serum Scr,NGAL and their combination had higher diagnostic value for the prognosis of CHB-LC patients,AUC area was 0.798,0.821,0.908,respectively.Conclusion:The serum levels of Scr,TBil,AST,ALT,INR and NGAL in patients with CHB-LC are higher,and they are related to liver function classification and prognosis.Scr and NGAL are risk factors affecting the prognosis of patients with CHB-LC and can be used as prognostic indicators.