血清前白蛋白、胆碱酯酶及胆汁酸在评价肝硬化患者肝脏储备功能及其变化中的临床价值

目的探讨血清前白蛋白(PAB)、胆碱酯酶(CHE)与胆汁酸(TBA)评价肝硬化患者肝脏储备功能及其变化的作用.方法选取经临床诊断的83例肝炎肝硬化患者,均严格按Child-Pugh评分进行分级(A、B、C 组).检测血清PAB、CHE、TBA与常规生化指标,部分患者进行治疗前后的对比.另选健康组(20例)作为对照组.结果 PAB与CHE在肝硬化Child-Pugh A、B、C组间两两比较差异有显著性(P＜0.01).PAB在Child-Pugh A组与正常组比较差异有显著性(P＜0.01).TBA在Child-Pugh C组与健康组/Child-Pugh A组相比差异有显著性(P＜ 0.01).白蛋白(ALB)正常的39例Child-Pugh A级患者中 33 例PAB低于正常值.将PAB、CHE对肝硬化Child-Pugh分级的诊断价值与常规指标ALB进行比较,三者诊断肝硬化Child-Pugh B的敏感度与特异度相同,但诊断Child-Pugh C时以PAB的敏感度较高,以ALB与CHE的特异度较好.治疗前后PAB、CHE有显著性差异,而TBA、ALB无显著性差异.结论 PAB、CHE较准确反映了肝硬化患者肝脏的储备功能及其变化.TBA不及PAB、CHE敏感.

The clinic value of prealbumin,cholinesterase and total bile acid in evaluating liver reserve function and its change in patients with liver cirrhosis

Objective To investigate the role of prealbumin(PAB), cholinesterase(CHE) and total bile acid(TBA) in evaluating liver reserve function and its change in patients with liver cirrhosis. Methods Eighty-three serum samples from patients with liver cirrhosis were detected for PAB, CHE, TBA and other biochemical markers. All patients were classified in accordance with Child-Pugh scale. The serum levels of these indexes before and after treatment were compared. Results The difference of PAB, CHE among Child-Pugh A, B, C were statistically significant(P<0.01). The difference of PAB between Child-Pugh A and healthy group was statistically significant(P<0.01). But for TBA, only the difference between Child-Pugh C group and healthy group / Child-Pugh A group was statistically significant. The clinic values of PAB and CHE in diagnosing Child-Pugh grade were compared with ALB. ROC analysis showed: sensitivity and specificity of PAB, ALB and CHE in diagnosing Child-Pugh B were similar. In diagnosing Child-Pugh C, the sensitivity of PAB was higher than ALB and CHE. Reversely, the specificity of PAB was inferior to ALB and CHE. Before and after treatment, the serum levels of PAB, CHE were statistically significant. Conclusion PAB and CHE reflect appropriately not only liver reserve function, but also its change in patients with liver cirrhosis. The role of TBA is inferior to PAB and CHE.