低白蛋白血症与肝硬化早期腹水的关系研究  

Analysis of the relationship between hypoalbuminemia and early ascites in cirrhosis

作　　者：聂鑫[1] 贺勇[1] 杨正兵[2] 张国福[1] 李贵星[1] 周汶静[1] 胡科妍[1] 

机构地区：[1]四川大学华西医院实验医学科,四川成都610041 [2]四川大学华西医院消化内科

出　　处：《中国实验诊断学》2013年第3期479-483,共5页Chinese Journal of Laboratory Diagnosis

基　　金：四川省科技支撑项目(2010SZ0252)

摘　　要：目的分析早期肝硬化有腹水与无腹水患者的临床资料、实验室指标及血液动力学状态,探讨低白蛋白血症与肝硬化早期腹水的关系。方法纳入我院2008年1月至2010年10月初次就诊的肝硬化住院患者118例,其中病例组38例,对照组80例。测定肝硬化患者血压和心率;分析肝功能、肾功能、电解质、血液学、血凝指标、一氧化氮和醛固酮水平;记录24小时尿量。对比分析两组患者的测定指标。结果肝硬化入院患者腹水发生率为32.2%。病例组原发病以酒精性肝硬化(50.0%)和乙肝肝硬化(34.2%)为主,child-pugh分级以C级(65.8%)为主。实验室指标中,病例组血清白蛋白为27.7±5.9g/L,低于对照组的30.2±6.1g/L(t=2.201,P<0.05),碱性磷酸酶和谷氨酰转肽酶结果分别为167±147U/L和131±173U/L,高于无腹水组的119±80U/L、76±93U/L(t值分别为2.092和2.074,P<0.05),其它肝功能指标、肾功能、血氨、电解质、血液学和血凝指标在两组间比较差异无统计学意义(P>0.05)。血液动力学指标中,病例组24小时尿量为1184±605ml,低于对照组的1473±839ml(t=2.013,P<0.05),而血压和心率在两组间比较差异无统计学意义(P>0.05)。病例组醛固酮水平为18.74±14.18ng/dl,高于无腹水组的10.99±7.17ng/dl,(t=2.224,P<0.05),两组间一氧化氮水平差异无统计学意义(P>0.05)。结论低白蛋白血症是肝硬化早期腹水产生的关键因素。Objective To discuss the effect of hypoalbuminemia on formation of early ascites in patients with liver cirrhosis through comparing the clinical data,laboratory parameters and hemodynamic status of cirrhosis patients with and without ascites. Methods Between January 2008 and October 2010 we recruited 118 initially diagnosed patients with liver cirrhosis admitted to our hospital, monitored the blood pressure and heart rate, obtained fasting blood and ser- um samples for standard hematological, biochemical,coagulation tests as well as nitric oxide and aldosterone, recorded 24-hour urine volume and compared all the parameters between the patients with and without ascites. Results 38 pa- tients （32.2% of the cohort） were diagnosed with ascites on the first day of admission. The majority of our patients presented with ascites due to alcoholic liver cirrhosis （50.0%） or Chronic hepatitis B （34.2 % ）, with 65.8% of the pa- tients classifying for Child-Pugh scores C. Serum albumin levels and 24-hour urine volume levels in patients with ascites （27.7±5.9g/L and 1185±599ml） showed a significantly （P〈0.05） reduction in comparison to those without （30.2 ±6. lg/L and 1473±812ml） ; alkaline phosphatase, y-glutamyltransferase, and aldosterone levels （ 167±147U/L, 131±173U/L and 18.74-4-14.18ng/dl） presented a significantly （P〈0.05） increase in comparison to those without （119± 80U/L,76±93U/L and 10.99±7.17ng/dl） while other parameters did not differ and all were in normal range at the time of admission. Conclusion Hypoalbuminema is the crucial factor for the formation of early ascites in patients with liver cirrhosis.

关 键 词：肝硬化 腹水 低白蛋白血症 机制 

分 类 号：R575.2[医药卫生—消化系统]