失代偿期肝硬化患者SAAG、PA、PTA水平与肝功能分期及预后的关系  

Relationship between levels of serum-ascites albumin gradient, serum prealbumin and prothrombin activity and grade of liver function and prognosis in patients with decompensated liver cirrhosis

作　　者：黄雪[1] 刘传苗[1] 赵守松[1] 赵久法[1] 高春明[1] 徐葵花[1] 

机构地区：[1]蚌埠医学院第一附属医院感染病科,安徽省蚌埠市233000

出　　处：《世界华人消化杂志》2016年第5期790-795,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨血清腹水白蛋白梯度(serumascites albumin gradient,SAAG)、前白蛋白(serum prealbumin,PA)与凝血酶原活动度(prothrombin activity,PTA)对肝硬化患者肝功能分期及预测预后的意义.方法:将66例肝硬化腹水患者根据ChildPugh评分分为Child B级组(28例)、Child C级组(38例)和按照住院期间临床疗效分为好转组(41例)与未愈组(25例).取入院次日肘静脉血液测定血清白蛋白(albumin,ALB)、球蛋白(globulin,GLB)、PA、总胆红素(total bilirubin,TBIL)、肌酐(creatinine,Cr)、血钠(sodium,Na)、血小板(platelet,PLT)及PTA水平,同时测定同日腹水ALB浓度计算SAAG,并行肝胆胰脾彩超测量门静脉直径.结果:(1)SAAG水平与血ALB、PA及门静脉直径正相关,与PLT、血小板/门静脉宽度及Child-Pugh分值负相关;(2)Child B、C两组血ALB、SAAG、PA、PTA间差别均具有统计学意义(P<0.05),好转组患者SAAG、PA、PTA水平明显高于未愈组,存在显著差异(P<0.05);(3)SAAG、PA、PTA结合终末期肝病模型(model for end-stage liver disease i n s e r u m s o d i u m,M E L D-N a)模型较单纯MELD-Na模型在判断疗效与预后方面有显著差异(P<0.05).结论:SAAG反映了门脉高压程度,联合检测PA、P TA能敏感、可靠地评估失代偿期肝硬化患者的肝功能,且在预后预测中有重要价值.AIM： To investigate the use of serum-ascites albumin gradient（SAAG）, serum prealbumin（PA） and prothrombin activity（PTA） for grading of liver function and evaluating prognosis in decompensated liver cirrhosis patients.METHODS： Sixty-six cirrhotic patients with ascites were divided into two groups according to either the modified Child-Pugh classification（Child B and Child C） or therapeutic effect（ positive and negative）. Blood from the median cubital vein was taken for detecting serum albumin（ALB）, globulin（GLB）, PA, total bilirubin（TBIL）, creatinine（Cr）, sodium（Na）, platelet（PLT）, and PTA. The albumin in ascites was determined on the same day to calculate SAAG, and abdominal ultrasound was performed to measure the diameter of the portal vein.RESULTS： SAAG had a positive correlation with ALB, PA and portal vein diameter, and a negative correlation with PLT, platelet/portal vein width and Child-Pugh score. The levels of ALB, SAAG, PA and PTA differed significantly between the Child B and Child C groups（P〈0.05）. The SAAG, PA and PTA weresignificantly higher（P〈0.05） in the positive group than in the negative group. SAAG, PA and PTA combined with model for end-stage liver disease in serum sodium（MELD-Na） were significantly better（P〈0.05） than MELDNa alone in evaluating the curative effect and prognosis.CONCLUSION： SAAG reflects the degree of portal hypertension, and the joint detection of PA and PTA is sensitive and reliable in the assessment of the liver function of decompensated liver cirrhosis patients, and has important value in prognosis prediction.

关 键 词：血清腹水白蛋白梯度 前白蛋白 凝血酶原活动度 CHILD-PUGH评分 终末期肝病模型 

分 类 号：R575.2[医药卫生—消化系统]