血清S100B对肝性脑病的实验诊断及临床应用研究
发布时间：2018-10-24 15:56
【摘要】：肝性脑病(hepatic encephalopathy，HE)是肝硬化常见的并发症之一，仅次于食管胃底静脉曲张破裂出血，为严重的并发症和常见的死亡原因。早期诊断HE可降低患者死亡率和神经系统后遗症。目前HE的诊断主要以临床表现为主，依赖脑诱发电位(brain evoked protentials,BEP)、数字连接试验(number connecting tests,NCT)、数字符号试验等神经生理和神经心理方法以及CT、MRI等影像的异常表现，实验室检查主要为血氨(Ammonia, NH3)增高，但较为单一，缺乏其他准确、可靠的检测指标或方法进行早期临床诊断。 目的:检测血清S100B、NH3及离子Na、Cl在HE组、非HE组及正常对照组中的含量变化，建立ROC曲线，确定血清S100B诊断HE临界值、灵敏度及特异度，同时明确血清S100B联合NH3诊断HE提高的灵敏度及特异度，观察HE在入院后不同时间时血清S100B的含量变化，分析血清S100B和NH3与HE病因分型、临床分期的关系，推测血清S100B和NH3的相关性，为HE的诊断提供新的实验诊断指标及临床应用价值。 方法:收集2011年5月-2012年12月在吉林大学第一医院肝病内科住院并且临床资料完整的97例患者的血清标本，其中HE组52例、非HE组45例，同时收集50例正常人的血清标本作为正常对照组。采用ELISA双抗体夹心法检测血清S100B的表达水平，应用谷氨酸脱氢酶法检测NH3浓度。采用选择性电极方法检测离子Na、Cl的含量。 结果: 1.血清S100B、NH3及离子Na、Cl在不同组别中的检查结果：HE组血清S100B及NH3含量较非HE组和正常对照组明显增高(P＜0.05)。HE组离子Na、Cl水平较非HE组和正常对照组减低(P＜0.05)。非HE组血清S100B及NH3含量均较正常对照组明显增高(P＜0.05)。非HE组离子Na、Cl水平较非HE组和正常对照组减低(P＜0.05)。 2.血清S100B及NH3的ROC曲线：(1)血清S100B、NH3的临界值分别为0.325ng/mL、158.5μmol/L。(2)血清S100B灵敏度(71.2%)低于NH3(84.0%)、特异度(76.9%)高于NH3(71.1%)。两者联合检测的灵敏度及特异度分别为84.0%、86.7%，高于单一检测指标(P＜0.05)。 3.血清S100B浓度变化与HE临床治疗效果的关系：HE期血清S100B表达增高，经过治疗HE病情得到控制后，病程第3～5天、7～9天分别复查血清S100B，均较治疗前明显减低(P＜0.05)。 4.血清S100B、NH3含量和HE病因分型、临床分期的关系：(1)不同临床分期(I、II、III、IV期)的HE患者血清S100B和NH3含量呈Ⅰ期至Ⅳ期呈逐渐上升趋势，差异具有统计学意义(P＜0.05)。(2)不同病因分型(A、B、C型)的HE患者血清S100B浓度改变无明显差异；门-体旁路性HE(B型)和慢性肝硬化性HE(C型)患者NH3浓度升高、而急性肝功能衰竭性HE(A型)患者NH3浓度正常。 5.血清S100B浓度变化与NH3含量的关系：HE组血清S100B浓度变化与NH3含量一致，二者呈正相关关系(r=0.729，P＜0.05)。 结论: 1.血清S100B在HE组高于非HE组，当检测水平分别高于0.325ng/mL、158.5μmol/L时，，对HE的诊断具有参考意义。 2.血清S100B含量变化与HE临床治疗效果相一致，可以为HE的临床治疗进程提供监测。 3.血清S100B和NH3含量与HE临床分期相关，NH3在B型门-体旁路性、C型慢性肝硬化性HE中升高明显，二者的检测对HE的临床分期与病因分型具有鉴别诊断意义。 4.血清S100B诊断的特异度均较高，NH3诊断灵敏度较高。血清S100B与NH3有一定的相关性(r=0.729，P＜0.05)，联合检测时对HE的诊断更有指导意义。
[Abstract]:Hepatic encephalopathy (HE) is one of the most common complications in liver cirrhosis. Early diagnosis of HE can reduce patient mortality and neurological sequelae. At present, HE's diagnosis is mainly based on clinical manifestation, dependence on brain evoked potential (BEP), digital connection test (NCT), digital sign test and other neurophysiological and neuropsychological methods as well as abnormal manifestations of CT, MRI and other images, and laboratory examination is mainly blood ammonia (Amminia, NH3) is increased, but is more single, lacking other accurate, reliable detection indexes or methods for early clinical diagnosis. Objective: To detect the changes of serum vitamin B, NH3 and Na, Cl in HE group, non-HE group and normal control group, establish ROC curve, determine the value, sensitivity and specificity of serum HBB in diagnosis of HE, and also make clear the sensitivity and specificity of serum S100B combined with NH3 in diagnosis of HE enhancement. The changes of serum vitamin B contents at different time after admission were observed. The relationship between serum vitamin B and NH3 and HE etiology and clinical stages was analyzed. The correlation between serum S100B and NH3 was estimated, and a new experimental diagnostic index and clinical application were provided for the diagnosis of HE. Methods: The serum samples of 97 patients were collected from May 2011 to December 2012 in the First Affiliated Hospital of Jilin University. Among them, 52 cases of HE group and 45 non-HE groups were collected, and serum samples of 50 normal subjects were collected. In the normal control group, the expression level of serum S100B was detected by ELISA double antibody sandwich method, and glutamate dehydrogenase method was used to detect the expression level. NH3 concentration. Ion Na was detected by selective electrode method. Cl鐨
本文编号：2291837
[Abstract]:Hepatic encephalopathy (HE) is one of the most common complications in liver cirrhosis. Early diagnosis of HE can reduce patient mortality and neurological sequelae. At present, HE's diagnosis is mainly based on clinical manifestation, dependence on brain evoked potential (BEP), digital connection test (NCT), digital sign test and other neurophysiological and neuropsychological methods as well as abnormal manifestations of CT, MRI and other images, and laboratory examination is mainly blood ammonia (Amminia, NH3) is increased, but is more single, lacking other accurate, reliable detection indexes or methods for early clinical diagnosis. Objective: To detect the changes of serum vitamin B, NH3 and Na, Cl in HE group, non-HE group and normal control group, establish ROC curve, determine the value, sensitivity and specificity of serum HBB in diagnosis of HE, and also make clear the sensitivity and specificity of serum S100B combined with NH3 in diagnosis of HE enhancement. The changes of serum vitamin B contents at different time after admission were observed. The relationship between serum vitamin B and NH3 and HE etiology and clinical stages was analyzed. The correlation between serum S100B and NH3 was estimated, and a new experimental diagnostic index and clinical application were provided for the diagnosis of HE. Methods: The serum samples of 97 patients were collected from May 2011 to December 2012 in the First Affiliated Hospital of Jilin University. Among them, 52 cases of HE group and 45 non-HE groups were collected, and serum samples of 50 normal subjects were collected. In the normal control group, the expression level of serum S100B was detected by ELISA double antibody sandwich method, and glutamate dehydrogenase method was used to detect the expression level. NH3 concentration. Ion Na was detected by selective electrode method. Cl鐨
本文编号：2291837
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