乙型肝炎肝硬化患者肝性脑病形成诱因及不同分期血清甲状腺激素、S100B水平情况  

Causes of Hepatic Encephalopathy and Serum Levels of Thyroid Hormone and S100 Bat Different Stages in Patients with Hepatitis B Cirrhosis

作　　者：曹焕焕[1] 殷思纯[1] 朱海鹏[1] 

机构地区：[1]东莞市人民医院感染科,广东东莞523000

出　　处：《实用临床医学（江西）》2017年第6期10-12,15,共4页Practical Clinical Medicine

摘　　要：目的探讨乙型病毒性肝炎(乙型肝炎)肝硬化患者肝性脑病(HE)形成诱因及不同临床分期血清甲状腺激素、S100B水平情况。方法选取2014年1月至2016年1月期间收治的乙型肝炎肝硬化患者186例,对其进行回顾性分析,根据诊断是否合并HE分为HE患者组(95例)和非HE患者组(91例)。比较2组血清甲状腺激素[血清总甲状腺素(T4)和总三碘甲状腺素(T3)]水平及血清S100B水平;对HE患者根据West-Haven分级标准进行临床分期,分析其诱因构成,并对不同临床分期时T3、T4及S100B水平进行比较。结果 HE患者组T3、T4水平明显低于非HE患者组,血清S100B水平明显高于非HE患者组(均P<0.000 1)。HE患者临床分期:Ⅰ期26例,Ⅱ期34例,Ⅲ期18例,Ⅳ期17例;HE形成诱因:乙型肝炎病毒感染37例(38.94%),乙型肝炎患者高蛋白摄入过量12例(12.63%),镇静药物使用4例(4.21%),其他因素(水电解质紊乱6例、饮酒3例、腹泻3例、不明原因3例)15例(15.78%),多种诱因合并(2个及以上因素)27例(28.42%);随着HE分期的上升,患者的T3、T4水平呈下降趋势,血清S100B水平呈上升趋势(均P<0.001)。结论随着肝硬化HE病变程度的进展,血清甲状腺激素水平和血清S100B的测定有助于评估乙型肝炎肝硬化HE的严重程度。Objective To investigate the causes of hepatic encephalopathy（HE）and serum levels of thyroid hormone and S100 Bat different stages in patients with hepatitis B cirrhosis.Methods Data of 186 hepatitis B cirrhosis patients hospitalized from Janurary 2014 to Janurary 2016 were analyzed retrospectively.These patients were divided into HE group（95patients）and nonHE group（91patients）.Serum levels of triiodothyronine（T3）,thyroxine（T4）and S100 B were compared between the two groups.HE was clinically staged according to the West-Haven classification criteria,and the composition of causes was analyzed.In addition,serum levels of T3,T4 and S100Bwere compared among different clinical stages.Results Compared with non-HE group,serum T3 and T4levels decreased and S100 Bincreased in HE group（P〈0.000 1）.According to the West-Haven classification of HE,26 patients were classified in stageⅠ,34 patients in stageⅡ,18 patients in stageⅢ,and 17 patients in stageⅣ.The causes of HE included hepatitis B virus infection（37cases,38.94%）,excessive protein intake（12cases,12.63%）,sedative drug use（4cases,4.21%）,and other factors（15cases,15.78%,6cases of water and electrolyte disturbance,3cases of alcohol drinking,3cases of diarrhea,and 3cases of unknown etiology）.HE was caused by multiple factors in 27patients（28.42%）.Serum T3 and T4levels decreased and S100 Blevels increased with the increase in HE stage（P〈0.001）.Conclusion With the progression of HE in cirrhosis,the determination of serum thyroid hormone and S100 Blevels are helpful to assess the severity of HE in patients with hepatitis B cirrhosis.

关 键 词：肝硬化 乙型病毒性肝炎 肝性脑病 诱因 不同分期 

分 类 号：R575.3[医药卫生—消化系统] R575.2[医药卫生—内科学]