慢性重型肝炎的血清生化指标对预后的影响

目的:探讨慢性重型肝炎(Chronic serious hepatitis,CSH)血清生化指标与预后的关系。方法:225例CSH患者,根据2000年北京传染性疾病会议制定的标准。分为早、中、晚3期,分别检测患者血清中总胆红素(TB)、白蛋白(A)、尿素氮(UN)、肌酐(CR)和胆碱酯酶(CHE)。10例病人同时进行肝脏穿刺病理检查,并观察合并症及预后。结果:早、中、晚3期TB(μmol/L)依次为326.62±111.03、399.80±125.60、385.05±107.84,早期与中、晚期对比,P<0.001;A(g/L)为32.48±4.64、29.66±5.72、29.26±3.69,早期与中晚期相比P<0.001;CHE(μ)2664.25±1004.27、1997.12±833.30、1997.23±874.39,早期与中晚期相比P<0.01;UN为20.23±8.84、21.39±8.78、25.58±10.02,早期与晚期相比P<0.01;CR为85.09±59.73、91.78±60.64、124.37±85.72,早期与晚期相比P<0.01。肝穿结果显示,CSH晚期大块、亚大块坏死较多,瘀胆严重,合并症多。结论:本文结果显示,CSH血清生化指标中TB、CR、UN越高,A、CHE越低,肝脏病理损伤越重,合并症越多,预后越差。

The Relationship between Serous Biochemical Indexes of Chronic Serious Hepatitis and Its Prognosis

Objective: To study the relationship between the serum biochemical indexes of chronic serious hepatitis and the prognosis. Methods: 225 cases of CSH were devided into three groups - early, middle and later stage, according to the standard of 2000 Beijing infectious disease meeting. The levels of total bilirubin ( TB ) , albumin ( A ) , urea nitrogen ( UN ) , creatinine ( CR ) and cholinesterate (CHE) were determined in the three groups and liver-biopsies were carried out in 10 cases at the same time.Complications and prognosis were also observed. Results: In proper order of the early, middle, later stages, TB(μmol/L) were 326.62± 111.03,399.80±125.60,385.05 ±107.84;A(g/L) were 32.48 ± 4.64,29.66± 5.72,29.26 ± 3.69;CHE(μ) were 2664.25 ± 1004.27,1997.12 ±833.30,1997.23 ±874.39;UN(mmol/L)20.23 ±8.84,21.39 ±8.78,25.58 ± 10.02;CR(μmol/L)85.09 ± 59.73,91.78 ±60.64,124.37 ±87.72. If these data in early stage were compared with that in middle and later stages, the differences between them would be remarkable (P<0.001 or P < 0.01). More masses necrosis, more serious cholestasis and more complications were also found in the later stage. Conclusion:The results show that the higher the levels of TB, CR, UN, the lower the levels of A and CHE in the serum of CSH, the more serious the liver masses necrosis, the more the complications, and the more unfavorable the prognosis.