肝硬化患者血清前白蛋白、血清胆碱酯酶和总胆汁酸水平检测的临床意义

Clinical significance of serum prealbumin,serum cholinesterase and total bile acid levels in patients with liver cirrhosis

目的 探讨肝硬化患者血清前白蛋白(PA)、血清胆碱酯酶(CHE)和总胆汁酸(TBA)水平的临床意义。方法 选取2018年2月~2019年11月我院收治的205例肝硬化患者,采用Child-Pugh评分按肝功能不同分级分为A级(A组,n=54)、B级(B组,n=86)、C级(C组,n=65),另选择同期来院体检的健康人群185例作为对照组。比较各组血清PA、CHE和TBA水平,并分析上述指标与患者病情相关性。随访1年,根据肝硬化患者预后分为存活组和死亡组,分析血清PA、CHE和TBA水平对预后的预测价值。结果 血清PA、CHE水平比较:C组<B组<A组<对照组,TBA水平比较:C组>B组>A组>对照组,差异均有统计学意义(P<0.05);血清PA、CHE水平与肝功能分级呈负相关,血清TBA水平与肝功能分级呈正相关(P<0.05);死亡组患者血清PA、CHE水平显著低于存活组,血清TBA水平显著高于存活组(P<0.05);ROC曲线显示联合检测AUC值、特异度明显高于单一检测(P<0.05)。结论 血清前白蛋白、血清胆碱酯酶、总胆汁酸水平可较为敏感的反映肝硬化患者肝功能损害程度,与肝功能分级以及预后密切相关,三者联合检测可更好的预测肝硬化患者预后情况,有望成为监测肝硬化患者肝功能以及预后的有效指标。

Objective To study the clinical significance of serum prealbumin(PA),serum cholinesterase(CHE)and total bile acid(TBA)levels in patients with liver cirrhosis.Methods Totally 205 patients with liver cirrhosis and 185 healthy people(control group)were enrolled in this study between February 2018 and November 2019.Serum PA,CHE and TBA levels were detected.According to Child-Pugh score,the patients'liver function was classified into A,B and C grades.Serum PA,CHE and TBA levels in patients with different grades of liver function were compared,and the correlation between the above indicators and the patient's condition was analyzed.According to the prognosis in 1-year follow-up,patients with liver cirrhosis were divided into survival group and death group.The prognostic value of serum PA,CHE and TBA levels was analyzed.Results Serum PA and CHE levels in patients with grade C,grade B,grade A liver function,and the control group increased in order,while TBA levels in patients with grade C,grade B,grade A liver function,and the control group decreased in order(P<0.05).Serum PA and CHE levels were negatively correlated with the grade of liver function,while serum TBA level was positively correlated with the grade of liver function(P<0.05).Serum PA and CHE levels in the death group were significant lower than those in the survival group,and serum TBA level was significantly higher than that in the survival group(P<0.05).ROC curve analysis showed that the AUC value and specificity of combined detection were significantly higher than that of single detection(P<0.05).Conclusion Serum PA,CHE and TBA levels can more sensitively reflect the degree of liver damage in patients with liver cirrhosis,and they are closely related to liver function classification and prognosis.The combination of the three can better predict the prognosis of patients with liver cirrhosis.Therefore,they are expected to be effective indicators for monitoring liver function and prognosis of patients with liver cirrhosis.