血清前白蛋白检测评价肝功能损害的临床应用

目的 探讨血清前白蛋白浓度测定在临床肝功能损害评价中的价值.方法 分析80例接受脾切除+贲门周围血管离断术的肝硬化患者术前血清前白蛋白(PA)水平、终末期肝病模型(MELD)与术后出现肝功能衰竭的关系.结果 术后出现肝功能衰竭的患者术前的PA值为(79.8±28.5)mg/L,较术后未出现肝功能衰竭情况患者的术前PA值(149.6±31.5)mg/L明显降低(P＜0.01).单独使用MELD评分≥9分和PA值＜100mg/L来判断肝硬化门脉高压患者术后是否出现肝功能衰竭的敏感性分别为71.4%和69.6%,使用MELD评分联合PA值来判断术后是否出现肝功能衰竭的敏感性为82.4%,明显高于单独使用MELD和PA值(P＜0.01).单独使用MELD评分≥9分、PA值＜100 mg/L和MELD评分联合PA值三种方法对术后肝功能衰竭情况评价的特异性都较强,分别为93%、91.5%和90.5%,但三种方法之间的差异无统计学意义(P＞0.05).结论 前白蛋白可反映乙肝后肝硬化门脉高压患者的肝功能损害程度.术前MELD评分联合PA值评估术后是否出现肝功能衰竭情况有良好的敏感性及特异性,可应用于临床.

Abstract：

Objective To investigate the clinical use of serum prealbumin (PA) in evaluating liver function damage. Methods Preoperative PA and the model for end-stage liver disease (MELD) score were retrospectively analyzed in 80 patients with liver cirrhosis and portal hypertension undergoing splenectomy and devascularization around the cardia. The correlation of preoperative PA level and MELD score with postoperative hepatic failure was also analyzed. Results The mean serum value of PA in the patients with hepatic failure was (79. 8 ± 28.5 ) mg/L, and that in thouse without hepatic failure was ( 149. 6 ±31.5 ) mg/L ( P ＜ 0. 01 ). The sensitivity of using MELD score ≥9 to evaluate postoperative hepatic failure was 71.4%, that of PA ＜ 100 mg/L was 69. 6%, and that of MELD score ≥9 combined with PA ＜ 100mg/L was 82. 4% respectively (P ＜0. 01 ). The specificity of the three methods was 93%, 91.5% and 90. 5% respectively, with the difference being not significant (P ＞ 0. 05). Conclusion The serum level of PA could reflect the liver function damage sensitively and exactly. Preoperative MELD score combined with serum PA has good sensitivity and specificity in predicting postoperative hepatic failure and could be used clinically.

Clinical value of MELD score combined with serum preaibumin in evaluating liver function damage

Objective To investigate the clinical use of serum prealbumin (PA) in evaluating liver function damage. Methods Preoperative PA and the model for end-stage liver disease (MELD) score were retrospectively analyzed in 80 patients with liver cirrhosis and portal hypertension undergoing splenectomy and devascularization around the cardia. The correlation of preoperative PA level and MELD score with postoperative hepatic failure was also analyzed. Results The mean serum value of PA in the patients with hepatic failure was (79. 8 ± 28.5 ) mg/L, and that in thouse without hepatic failure was ( 149. 6 ±31.5 ) mg/L ( P ＜ 0. 01 ). The sensitivity of using MELD score ≥9 to evaluate postoperative hepatic failure was 71.4%, that of PA ＜ 100 mg/L was 69. 6%, and that of MELD score ≥9 combined with PA ＜ 100mg/L was 82. 4% respectively (P ＜0. 01 ). The specificity of the three methods was 93%, 91.5% and 90. 5% respectively, with the difference being not significant (P ＞ 0. 05). Conclusion The serum level of PA could reflect the liver function damage sensitively and exactly. Preoperative MELD score combined with serum PA has good sensitivity and specificity in predicting postoperative hepatic failure and could be used clinically.