不同Child-Pugh分级肝硬化患者糖化白蛋白的测定及其应用价值

Measurement of glycosylated albumin and its application value in liver cirrhosis patients with different Child-Pugh classes

目的探讨不同Child-Pugh分级肝硬化患者糖化白蛋白(GA)水平及其在预测肝功能方面的应用价值。方法纳入2019年1月1日—12月31日于天津市第三中心医院住院治疗的肝硬化患者486例,其中肝硬化未合并糖尿病患者227例,肝硬化合并糖尿病患者259例。按照Child-Turcotte-Pugh(CTP)评分进行分组,测定空腹血糖、糖化血红蛋白、糖化白蛋白百分比(GA%)。非正态分布的计量资料3组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Dwass-Steel-Critchlow-Fligner检验。绘制CTP评分与GA%之间的散点图和拟合曲线,评估二者的关系,并计算cut-off值。结果肝硬化未合并糖尿病患者不同Child-Pugh分级之间GA%(χ^(2)=24.809,P<0.001)、空腹血糖(χ^(2)=11.899,P=0.003)、糖化血红蛋白(χ^(2)=13.607,P=0.001)比较差异均有统计学意义,进一步两两比较显示,Child-Pugh A级、B级肝硬化未合并糖尿病患者与C级相比,GA%差异均有统计学意义(P值均<0.05);Child-Pugh A级患者空腹血糖水平明显高于Child-Pugh B级患者(P<0.05);Child-Pugh A级患者糖化血红蛋白水平明显高于Child-Pugh B级和C级患者(P值均<0.05)。肝硬化合并糖尿病患者不同Child-Pugh分级之间GA%(χ^(2)=10.734,P=0.005)、空腹血糖(χ^(2)=16.295,P<0.001)比较差异均有统计学意义,进一步两两比较显示,Child-Pugh C级肝硬化合并糖尿病患者GA%明显低于A级和B级(P值均<0.05);Child-Pugh A级患者空腹血糖水平低于B级患者(P<0.05)。拟合曲线结果显示,肝硬化未合并糖尿病患者随着CTP评分升高,GA%升高,在评分为6.5分时GA%最高,然后开始下降,评分为11.5分时GA%最低,呈曲线关系;肝硬化合并糖尿病患者的GA%随CTP评分增加呈现先升高后降低曲线,cut-off值为8分。结论随着肝硬化病情进展,GA%出现先升高后降低的变化。不同Child-Pugh分级肝硬化患者GA水平差异明显,提示GA的降低与终末期肝硬化肝功能失代偿密切相关。

Objective To investigate the level of glycosylated albumin(GA)in liver cirrhosis patients with different Child-Pugh classes and its application value in predicting liver function.Methods A total of 486 patients with liver cirrhosis who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31,2019,were enrolled,among whom 227 patients had liver cirrhosis without diabetes and 259 patients had liver cirrhosis with diabetes.The patients were divided into groups according to Child-Turcotte-Pugh(CTP)score,and fasting blood glucose,glycosylated hemoglobin,and percentage of GA(GA%)were measured.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between three groups,and the Dwass-Steel-Critchlow-Fligner test was used for further comparison between two groups.Scatter plots and fitting curves were plotted for CTP score and GA%to evaluate the association between them and calculate the cut-off value.Results For the cirrhosis patients without diabetes,there were significant differences between the patients with different Child-Pugh classes in GA%(χ^(2)=24.809,P<0.001),fasting blood glucose(χ^(2)=11.899,P=0.003),and glycosylated hemoglobin(χ^(2)=13.607,P=0.001);further pairwise comparison showed that there was a significant difference in GA%between Child-Pugh class A/B liver cirrhosis patients without diabetes and Child-Pugh class C liver cirrhosis patients(P<0.05),Child-Pugh class A patients had a significantly higher level of fasting blood glucose than Child-Pugh class B patients(P<0.05),and Child-Pugh class A patients had a significantly higher level of glycosylated hemoglobin than Child-Pugh class B/C patients(P<0.05).For the patients with liver cirrhosis and diabetes,there were significant differences between the patients with different Child-Pugh classes in GA%(χ^(2)=10.734,P=0.005)and fasting blood glucose(χ^(2)=16.295,P<0.001);further pairwise comparison showed that Child-Pugh class C liver cirrhosis patients with diabetes had a significantly lower GA%than Child-Pugh class A/B patients(P<0.05)and Child-Pugh class A patients had a significantly lower fasting blood glucose level than Child-Pugh class B patients(P<0.05).The fitting curve showed that GA%increased with the increase in CTP score in the liver cirrhosis patients without diabetes,reached the highest value at the CTP score of 6.5,and then started to decrease,with the lower value at the CTP score of 11.5,which showed a curvilinear relationship;in the liver cirrhosis patients with diabetes,GA%first increased and then decreased with the increase in CTP score,with a cut-off value of 8.Conclusion GA%first increases and then decreases along with the progression of liver cirrhosis.There is a significant difference in GA between liver cirrhosis patients with different Child-Pugh classes,suggesting that the reduction in GA is closely associated with liver function decompensation in end-stage liver cirrhosis.