APRI与血氨联合对肝硬化并肝性脑病的诊断价值评估

目的 探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值.方法 对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检测,并分析APRI、血氨值与HE之间的关系.结果 伴有HE患者的Child分级和MELD评分均高于无HE者,差异有统计学意义(P＜0.05).APRI值在HE组的值为4.38±2.68,高于无HE组的2.19±1.75,差异有统计学意义(t=-4.721,P＜0.001).APRI值在不同HE分级中的分布:1级3.70±0.55、2级5.30±0.43、3～4级5.75±1.27,1级＜2级＜3～4级,差异有统计学意义(H=6.704,P=0.035).血氨值在不同HE分级中的分布:1级(108.0±6.1) μg/dl、2级(130.4±23.4) μg/dl、3～4级(170.5± 12.5) μg,/dl,1级＜2级＜3～4级,差异有统计学意义(H=10.95,P=0.004).APRI与血氨联合诊断HE时,ROC曲线下面积为0.898,敏感度为91.8％,特异度为96.9％.结论 APRI和血氨联合检测诊断HE效能较高,具有较好的临床应用价值.

Diagnostic value of APRI combined with serum ammonia in patients with liver cirrhosis complicated with hepatic encephaiopathy

Objective To explore the value of AST and PLT ratio index (APRI) combined with serum ammonia in the diagnosis of hepatic encephalopathy (HE).Methods The serum level ofAST,PLT and blood ammonia were detected in 48 cirrhosis patients without HE and 48 cirrhosis patients with HE,and the relationship between APRI and blood ammonia value and HE were analyzed.Results The levels of Child-pugh and MELD were higher in HE patients than those in patients without HE (P ＜ 0.05).The value of APRI in the HE group was higher than that of the cirrhosis patients without HE,and the difference was statistically significant (4.38±2.68) vs.(2.19±1.75),t =-4.721,P ＜ 0.001].Level of blood ammonia in the HE group was higher than that of patients without HE (122.23±43.58)μg/dl vs.(70.94±25.71)μg/dl],and the difference was statistically significant (t =-7.023,P ＜ 0.001).APRI values in the grade 1,2 and 3～4 of hepatic encephalopathy were 3.697±0.546,5.296±0.433,5.747± 1.269,the difference was statistically significant (H =6.704,P =0.035).The blood ammonia concentration in the grade 1,2 and 3～4 of hepatic encephalopathy were (108.0±6.1)μg/dl,(130.4±23.4)μg/dl,(170.5±12.5)μg/dl,the difference was statistically significant (H =10.95,P =0.004).The sensitivity and specificity of combined detection of APRI and blood ammonia to diagnose HE were 91.8％ and 96.9％,respectively.Conclusion Combination of APRI and blood ammonia has a significant diagnosis value of HE,and has higher clinical application value.