谷丙转氨酶、谷草转氨酶、血清白蛋白联合凝血酶原时间对儿童心力衰竭严重程度的评估价值

Value of alanine aminotransferase,aspartate aminotransferase and serum albumin combined with prothrombin time in assessing the severity of heart failure in children

目的探讨谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清白蛋白(ALB)联合凝血酶原时间(PT)对判断儿童心力衰竭发展及预后的价值。方法回顾分析50例心力衰竭患儿的临床资料,按改良Ross心功能等级,心功能Ⅱ级15例,Ⅲ级14例,Ⅳ级21例;按预后分为存活31例和死亡19例。比较各组间ALT、AST、ALB、PT水平,分析ALT、AST、ALB、PT、Ross心功能等级与心力衰竭死亡的相关性。结果所有心力衰竭患儿的ALT中位数水平为95.0(141.2)U/L,AST为60.9(79.1)U/L,ALB为35.3(7.1)g/L,PT为(19.64±2.62)s。心功能Ⅱ级、Ⅲ级、Ⅳ级间ALB、AST、ALT、PT比较差异均有统计学意义(P<0.05)。除心功能Ⅱ级与Ⅲ级之间ALB差异无统计学意义(P>0.05)外,其他各组之间两两比较,ALB、ALT、PT比较差异均有统计学意义(P<0.05)。所有患儿心力衰竭程度与ALB分级之间呈负相关(r_(s)=-0.375,P<0.05),与ALT分级之间呈正相关(r_(s)=0.747,P<0.001),与AST分级之间无相关性(r_(s)=0.275,P>0.05),与PT分级之间呈正相关(r_(s)=0.352,P<0.05),Logistic回归分析发现Ross心功能等级越高,ALT值越高(OR=1.018,95%CI:1.006~1.030)、AST值越高(OR=1.010,95%CI:1.001~1.020),心力衰竭患儿死亡风险越大。结论ALT、AST、ALB联合PT、改良Ross心功能等级可评估心力衰竭患儿的病情严重程度,ALT联合改良Ross分级评分对评估其预后有重要临床意义。

Objective To explore the value of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and serum albumin(ALB)combined with prothrombin time(PT)in judging the development and prognosis of heart failure in children.Methods The clinical data of 50 children with heart failure was retrospectively analyzed,and the children were divided into cardiac function gradeⅡgroup(n=15),cardiac functionⅢgroup(n=14)and cardiac functionⅣgroup(n=21)according to modified Ross heart function grading,and into survival group(n=31)and death group(n=19)according to prognosis.The levels of ALT,AST,ALB and PT among the groups were compared,and the correlation between ALT,AST,ALB,PT,Ross cardiac function classes and death from heart failure was analyzed.Results The median ALT level of all children with heart failure was 95.0(141.2)U/L,AST was 60.9(79.1)U/L,ALB was 35.3(7.1)g/L,and PT was(19.64±2.62)s.The differences in ALB,AST,ALT and PT among cardiac function gradeⅡ,ⅢandⅣgroups were statistically significant(P<0.05).Except for the difference in ALB between cardiac function gradeⅡgroup andⅢgroup(P>0.05),the differences in ALB,ALT and PT were statistically significant(P<0.05)between each two groups among other groups.There was a negative correlation between the degree of heart failure and ALB grade in all children(r s=-0.375,P<0.05),a positive correlation with ALT grade(r s=0.747,P<0.001),no correlation with AST grade(r s=0.275,P>0.05),and a positive correlation with PT grade(r s=0.352,P<0.05).Logistic regression analysis found that the higher the Ross cardiac function level,the higher the ALT value(OR=1.018,95%CI:1.006-1.030)and the higher the AST value(OR=1.010,95%CI:1.001-1.020),the greater the risk of death in children with cardiac exhaustion.Conclusion ALT,AST and ALB combined with PT,and modified Ross cardiac function grading can assess the severity of heart failure,and ALT combined with modified Ross grading score has important clinical significance in evaluating the prognosis.