缺血修饰性白蛋白（IMA）在慢性肝病及慢性肾脏病间的差异及其临床意义探讨

发布时间：2018-06-16 06:21

本文选题：肝硬化 + 慢性肾脏病　；参考：《吉林大学》2014年硕士论文

【摘要】：目的通过对比肾病低蛋白血症及肝硬化低蛋白血症在IMA及IMAR上有无差异，阐明这些提示白蛋白功能的指标对肝硬化患者是否具有特异性；通过对肝硬化患者的研究论证其在评估肝硬化严重程度方面的价值及其与肝硬化病因之间的关系。方法 2013年2月～2014年2月吉林大学中日联谊医院消化内科住院的肝硬化患者及肾内科住院的慢性肾脏病患者，，排除合并严重心血管疾病、血液及内分泌系统疾病，病情尚未得到控制者；因原发性肝癌或其它恶性肿瘤导致的营养不良状态患者；合并缺血性疾病、氧化应激状态及酮症酸中毒患者、合并急性肾损伤患者。对入组的低蛋白血症组及非低蛋白血症组患者均测定其ALT、AST、ALB、TBIL、DBIL、凝血酶原INR值、BUN、CREA、RBP、尿蛋白水平、IMA水平、计算IMAR（IMA/ALB）；病比较两组患者间及不同亚组之间IMA及IMAR之间的差异；探讨肝硬化患者IMA及IMAR与肝脏炎症反应指标、肝脏合成、代谢、转运功能的相关指标及肾功能指标之间的关系，探讨肝硬化患者IMA及IMAR水平与其Child-Pugh评分之间的相关性及其与肝硬化病因之间的关系。结果（1）低蛋白血症组患者IMA及缺IMAR均明显高于非低蛋白血症组患者。（2）低蛋白血症组肝硬化合并肾损伤组患者IMA及IMAR较单纯性肾脏病组均明显升高，与单纯性肝硬化组相比无明显统计学差异。（3）非低蛋白血症组三个亚组之间相比在IMA及IMAR的差异均无统计学意义。（4）肝硬化患者IMA及IMAR与患者的转氨酶水平、肌酐、尿素氮、视黄醇结合蛋白及尿蛋白水平均无明显相关性之间无明显相关性，与胆红素水平及凝血酶原INR值之间呈正相关。（5）IMA及IMAR与肝硬化患者Child Pugh评分均呈正相关。（6）不同病因肝硬化患者之间IMA及IMAR之间的关系均为酒精性肝硬化丙型肝炎肝硬化其他原因肝硬化乙型肝炎肝硬化。结论低蛋白血症患者不仅白蛋白水平下降，白蛋白功能也明显减低，非低蛋白血症组患者白蛋白功能无明显改变；肝硬化患者白蛋白功能明显下降，而肾脏病患者白蛋白功能无明显改变；肝硬化患者白蛋白功能与肝硬化严重程度相关，其Child-Pugh评分越高，白蛋白功能越差。患者白蛋白功能与反映患者肝脏炎症反应程度的指标、肾功能相关指标之间无明显关系，与反应肝脏合成、代谢、转运功能的生化指标胆红素水平及凝血酶原INR值明显相关，这些生化指标越高，白蛋白功能越差；不同病因肝硬化患者之间白蛋白功能按依次递减的顺序为乙型肝炎肝硬化、其他原因肝硬化、丙型肝炎肝硬化、酒精性肝硬化。
[Abstract]:Objective to compare the difference of IMA and IMAR between hypoproteinemia of nephropathy and hypoproteinemia of liver cirrhosis, and to clarify whether these indicators of albumin function are specific to patients with liver cirrhosis. The value of liver cirrhosis in evaluating the severity of cirrhosis and its relationship with the etiology of cirrhosis were studied. Methods from February 2013 to February 2014, inpatients with liver cirrhosis and chronic kidney disease in Department of Digestive Medicine, Sino-Japanese Lianyi Hospital, Jilin University, were excluded from severe cardiovascular disease, blood and endocrine system diseases. Patients with uncontrolled condition; patients with malnutrition due to primary liver cancer or other malignant neoplasms; patients with ischemic diseases, oxidative stress and ketoacidosis; patients with acute renal injury. In the hypoproteinemia group and the non-hypoproteinemia group, the levels of alt, prothrombin INR, urinary protein and IMA were measured, and the difference of IMA and IMAR between the two groups were compared. To investigate the relationship between IMA and IMAR in patients with liver cirrhosis and the indexes of liver inflammation, liver synthesis, metabolism, transport function and renal function. To investigate the correlation between IMA and IMAR and Child-Pugh score and the relationship between IMA and IMAR and the etiology of cirrhosis. Results (1) IMA and IMAR in hypoproteinemia group were significantly higher than those in non-hypoproteinemia group. There was no significant difference in IMA and IMAR between the three subgroups of non-hypoproteinemia group and simple cirrhosis group. There was no significant correlation between retinol binding protein and urinary protein levels. A positive correlation was found between IMA and IMAR and Child's Pugh score in patients with liver cirrhosis. 6) the relationship between IMA and IMAR in patients with cirrhosis of different etiology was both alcoholic cirrhosis and hepatitis C liver. Cirrhosis of other causes Hepatitis B cirrhosis. Conclusion Albumin level and albumin function in patients with hypoproteinemia decreased significantly, while in patients with non-hypoproteinemia there was no significant change in albumin function, while in patients with cirrhosis, albumin function decreased significantly. The albumin function of patients with liver cirrhosis was correlated with the severity of cirrhosis, and the higher the Child-Pugh score, the worse the albumin function. There was no significant correlation between albumin function and the indexes reflecting the degree of inflammatory reaction in the liver, and there was no significant correlation between the serum albumin function and the related indexes of renal function, but the level of bilirubin and prothrombin INR were significantly correlated with the biochemical indexes of liver synthesis, metabolism and transport function. The higher these biochemical indexes were, the worse the albumin function was, and the decreasing order of albumin function among the patients with cirrhosis of different etiology was hepatitis B cirrhosis, other cirrhosis, hepatitis C cirrhosis and alcoholic cirrhosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

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