乙型肝炎肝硬化腹水患者SAAG及血清LDH、CA199、CA125水平观察

An observation of SAAG,LDH,CA199,and CA125 levels in hepatitis B-related cirrhotic patients with ascites

目的探讨血清-腹水白蛋白梯度(serum-ascites Albumin gradient,SAAG)及血清乳酸脱氢酶(lactate dehydrogenase,LDH)、癌胚抗原199(cancer antigen 199,CA199)和癌胚抗原125(cancer antigen 125,CA125)在乙型肝炎肝硬化腹水诊断和治疗中的应用价值。方法本研究采取回顾性分析方法,收集2018年6月—2022年6月核工业四一七医院和解放军联勤保障部队第九八七医院收治的94例乙型肝炎肝硬化腹水患者的临床资料。根据肝硬化Child-Pugh分级将患者分为A组(肝功能A级,n=23)、B组(肝功能B级,n=46)、C组(肝功能C级,n=25)。分别比较不同肝功能分级患者SAAG及血清LDH、CA199、CA125水平及其预后情况;采用logistic回归分析SAAG、血清LDH、CA199、CA125水平与肝功能分级的关系。绘制不同SAAG、血清指标水平患者的生存曲线。分析影响患者生存的危险因素。结果C组患者的SAAG为(22.34±2.69)g/L,血清LDH、CA199和CA125水平分别为(318.50±22.56)IU/L、(112.87±66.92)、(319.41±98.43),显著高于A组[SAAG为(15.97±2.64)g/L,血清LDH、CA199和CA125水平分别为(281.97±21.82)IU/L、8.09±5.94、19.27±13.91]和B组[SAAG为(18.86±2.61)g/L,血清LDH、CA199和CA125水平分别为(303.42±21.73)IU/L、60.52±40.63、210.56±134.76](P<0.05)。死亡组SAAG为(21.07±2.84)g/L、血清LDH、CA199和CA125水平分别为(309.86±22.57)IU/L、86.57±28.85、268.14±58.71均高于存活组[SAAG为(18.82±2.62)g/L,血清LDH、CA199和CA125水平分别为(289.47±21.93)IU/L、39.42±13.64、103.63±21.43](P<0.05)。ROC曲线显示,SAAG、血清指标水平、联合诊断对肝功能分级的AUC分别为0.863、0.885、0.971,联合诊断的敏感度、特异度分别为98.6%、95.7%。Logistic回归分析表明,入院时SAAG高水平、血清指标水平是患者肝功能分级为C级的独立危险因素(P<0.05);入院时SAAG呈高水平(≥21.68 g/L)的患者18个月生存率低于SAAG呈低水平(<21.68 g/L)的患者(P<0.05)。结论血清SAAG、LDH、CA199和CA125水平的升高与乙型肝炎肝硬化腹水的发生、发展有关。这些生化指标可作为乙型肝炎肝硬化腹水的辅助诊断工具,有助于早期诊断和疾病监测。

Objective To investigate the levels of Serum-Ascites Albumin Gradient(SAAG),Serum Lactate Dehydrogenase(LDH),Cancer Antigen 199(CA199),and Cancer Antigen 125(CA125)in hepatitis B-related cirrhotic patients with ascites,in order to assess the application value of these biochemical markers in the diagnosis and treatment of this condition.Methods A retrospective analysis was conducted on the clinical data of 94 hepatitis B-related cirrhotic patients with ascites collected from June 2018 to June 2022.According to the Child-Pugh classification of liver cirrhosis,patients were classified into Group A(liver function class A,n=23),Group B(liver function class B,n=46),and Group C(liver function class C,n=25).The levels of SAAG,serum LDH,CA199,and CA125,as well as the prognosis of patients across different liver function classifications were compared.Logistic regression analysis was used to analyze the relationship between the levels of SAAG,serum LDH,CA199,CA125,and liver function classification.The survival curves for patients with different levels of SAAG and serum markers were plotted.The risk factors affecting patient survival were analyzed.Results Patients in Group C had significantly higher levels of SAAG(22.34±2.69 g/L),serum LDH(318.50±22.56 IU/L),CA199(112.87±66.92),and CA125(319.41±98.43)compared to those of Group A[SAAG(15.97±2.64 g/L),serum LDH(281.97±21.82 IU/L),CA199(8.09±5.94),CA125(19.27±13.91)]and Group B[SAAG(18.86±2.61 g/L),serum LDH(303.42±21.73)IU/L,CA199(60.52±40.63),CA125(210.56±134.76)],with statistical significance(P<0.05).The deceased group exhibited higher levels of SAAG(21.07±2.84 g/L),serum LDH(309.86±22.57 IU/L),CA199(86.57±28.85),and CA125(268.14±58.71)compared to the survival group[SAAG(18.82±2.62 g/L),serum LDH(289.47±21.93 IU/L),CA199(39.42±13.64),CA125(103.63±21.43),also with statistical significance(P<0.05)].The ROC curve analysis shows that the AUCs for SAAG,serum marker levels,and combined diagnosis for liver function grading are 0.863,0.885,and 0.971,respectively.The sensitivity and specificity of the combined diagnosis are 98.6%and 95.7%,respectively.Logistic regression analysis indicates that high levels of SAAG and serum markers at admission are independent risk factors for patients’liver function being classified as Grade C(P<0.05);Patients with high levels of SAAG(≥21.68 g/L)at admission have a lower 18-month survival rate than those with low levels of SAAG(<21.68 g/L)(P<0.05).Conclusion Elevated levels of serum SAAG,LDH,CA199,and CA125 in hepatitis B-related cirrhotic patients are associated with the development of ascites.These biochemical markers can serve as auxiliary diagnostic tools for ascites in hepatitis B-related cirrhotic patients,which may facilitate early diagnosis and monitoring disease.