阻塞性黄疸肝损伤及慢性肝病患者血清肝活素水平测定的临床意义

发布时间：2018-05-08 09:17

本文选题：肝活素 + 肝损伤　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探究肝活素(HPS)在阻塞性黄疸所致肝损伤的诊断以及慢性肝病肝功能评估中的作用。方法:随机选择60例阻塞性黄疸患者、68例慢性肝病患者及30例健康体检者,ELISA法测定其血清HPS水平,丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、血浆白蛋白(ALB)、凝血酶原时间(PT)由我院检验科检测。根据得出的TBIL、ALB、PT综合有无肝性脑病和腹水对慢性肝病患者中无肝衰竭患者进行Child-Pugh分级(CPC),发生肝衰竭的患者则根据衰竭类型分组。68例慢性肝病患者,非肝衰竭者Child A级13例、Child B级21例、Child C级10例,肝衰竭者中CLF者13例,ACLF者11例。分析两种肝损伤患者与正常人血清HPS水平有无差异;绘制受试者工作特征曲线(ROC),通过观察AUC大小判断HPS对阻塞性黄疸所致肝损伤的诊断价值;对阻塞性黄疸患者血清HPS和ALT进行相关性分析;分析慢性肝病患者HPS与CPC以及肝衰竭之间的关系。结果:1.阻塞性黄疸和慢性肝病患者血清HPS水平均显著高于对照组(均P0.01)。2.HPS在阻塞性黄疸肝损伤诊断中的曲线下面积达到0.938,最佳节点是141.87ng/ml。3.阻塞性黄疸患者血清中HPS与ALT呈正相关,rs=0.914(P0.01)。4.慢性肝病中非衰竭者Child A、Child B、Child C与慢加急性肝衰竭(ACLF)、慢性肝衰竭(CLF)5组之间两两比较,非肝衰竭组中,随着CPC升高,HPS水平也逐渐升高(均P0.05),两组肝衰竭血清HPS水平均高于非衰竭各组(均P0.05),两组肝衰竭之间HPS水平差异无统计学意义(P=0.58)。结论:1.阻塞性黄疸肝损伤和慢性肝病患者血清HPS水平升高。2.血清HPS水平测定能够用于阻塞性黄疸肝损伤的诊断,且具有较高的准确性和特异性。3.阻塞性黄疸患者血清中HPS与ALT具有较好的正相关性,综合HPS本身增殖因子的特性,认为其能够更好地反映肝损伤严重程度。4.慢性肝病患者血清HPS水平随着病情严重程度的加重而升高,作为一种高特异性血清标记物配合CPC有可能对慢性肝病患者肝功能做出更为精确的评估,了解有无恶化趋势,预知肝衰竭的发生;同时配合肝衰竭诊断标准,早期诊断及时治疗,对降低肝衰竭患者并发症发生率和死亡率有重要的临床意义。
[Abstract]:Aim: to investigate the role of hepatoactive factor (HPS) in the diagnosis of liver injury caused by obstructive jaundice and the assessment of liver function in chronic liver disease. Methods: serum HPS levels were determined by Elisa in 68 patients with chronic liver disease and 30 healthy controls randomly selected from 60 patients with obstructive jaundice. Alanine aminotransferase (alt), total bilirubin (TBILL), plasma albumin (Alb), prothrombin time (PTT) were detected by our laboratory. According to the obtained TBILAL-ALBX PT, the patients with chronic liver failure were divided into eight groups according to the type of failure, including hepatic encephalopathy and ascites, with or without liver failure. There were 13 cases of Child A grade A and 21 cases of Child B grade C in non-hepatic failure, and 11 cases of CLF in 13 cases of liver failure. To analyze the difference of serum HPS level between the two kinds of liver injury patients and normal people, draw the operating characteristic curve of subjects and judge the value of HPS in the diagnosis of liver injury caused by obstructive jaundice by observing the size of AUC. The correlation between serum HPS and ALT in patients with obstructive jaundice and the relationship between HPS and CPC and liver failure in patients with chronic liver disease were analyzed. The result is 1: 1. The serum HPS levels in patients with obstructive jaundice and chronic liver disease were significantly higher than those in the control group (the area under the curve of all P0.01).2.HPS in the diagnosis of obstructive jaundice liver injury was 0.938, the best node was 141.87 ng / ml. 3). There was a positive correlation between serum HPS and ALT in patients with obstructive jaundice. There was a significant difference between Child ACLF C in patients with chronic liver failure and those with chronic and acute liver failure, chronic liver failure and chronic liver failure, in non-hepatic failure group. With the increase of CPC, the serum HPS level of liver failure group was higher than that of non-failure group (P 0.05). There was no significant difference in HPS level between the two groups. Conclusion 1. The serum HPS level in patients with obstructive jaundice liver injury and chronic liver disease was increased. 2. 2. The determination of serum HPS level can be used in the diagnosis of liver injury in obstructive jaundice with high accuracy and specificity. HPS and ALT in serum of patients with obstructive jaundice have good positive correlation. It is considered that HPS can better reflect the severity of liver injury by synthesizing the characteristics of proliferating factor of HPS itself. The level of serum HPS in patients with chronic liver disease increases with the severity of the disease. As a highly specific serum marker combined with CPC, it may be possible to make a more accurate assessment of liver function in patients with chronic liver disease and understand whether there is a trend of deterioration. It is important to predict the occurrence of liver failure and to combine with the diagnostic criteria of liver failure and early diagnosis and treatment to reduce the incidence of complications and mortality in patients with liver failure.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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