血清铜蓝蛋白、胰岛素抵抗指数与肝硬化患者Child-Pugh分级的关系  

Relationship between serum ceruloplasmin,insulin resistance index and Child-Pugh classification in patients with liver cirrhosis

作　　者：郑能[1] 陈炎[1] 于力力[2] ZHENG Neng;CHEN Yan;YU Lili(Department of Gastroenterology,the Second People's Hospital of Yibin,Yibin,Sichuan,China,644000;Yibin Center for Disease Control and Prevention,Yibin,Sichuan,China,644000)

机构地区：[1]宜宾市第二人民医院消化内科,四川宜宾644000 [2]宜宾市疾病预防控制中心,四川宜宾644000

出　　处：《分子诊断与治疗杂志》2021年第4期667-670,共4页Journal of Molecular Diagnostics and Therapy

基　　金：四川省卫生和计划生育委员会科研基金资助项目(18PJ109)。

摘　　要：目的探究血清铜蓝蛋白、胰岛素抵抗指数(HOMA-IR)与肝硬化患者Child-Pugh分级的关系。方法选取2015年7月至2018年12月本院收治的185例肝硬化患者纳入研究组,按照Child-Pugh分级标准划分为Child-Pugh A级组(58例)、Child-Pugh B级组(77例)、Child-Pugh C级组(50例),另择同期查体的100例健康志愿者作为对照组。测定各组受试者铜蓝蛋白、空腹血浆胰岛素(FINS)、空腹血浆葡萄糖(FPG)水平及HOMA-IR水平,分析血清铜蓝蛋白、HOMA-IR与Child-Pugh分级的相关性,绘制ROC曲线分析各指标诊断不同程度肝硬化患者的诊断价值。结果研究组FINS、HOMA-IR明显高于对照组,差异有统计学意义(P<0.05)。FINS、HOMA-IR:Child-Pugh C级>B级>A级,差异有统计学意义(P<0.05)。研究组血清铜蓝蛋白水平明显低于对照组,差异有统计学意义(P<0.05)。铜蓝蛋白:Child-Pugh C级<B级<A级,差异有统计学意义(P<0.05)。各组受试者FPG比较差异无统计学意义(P>0.05)。Spearman相关性分析示,研究组Child-Pugh分级与血清铜蓝蛋白呈负相关(r=-0.415,P<0.05),与HOMA-IR呈正相关(r=0.510,P<0.05)。ROC曲线示,血清铜蓝蛋白、HOMA-IR诊断肝硬化Child-Pugh分级B级+C级患者的曲线下面积分别为0.644、0.805,截点值分别为302.10 mg/L及2.80;血清铜蓝蛋白、HOMA-IR诊断肝硬化Child-Pugh分级C级患者的曲线下面积分别为0.719、0.874,截点值分别为320.20 mg/L及3.08。结论血清铜蓝蛋白、胰岛素抵抗指数与肝硬化患者Child-Pugh分级存在一定程度相关,可作为快速评估肝硬化肝功能的参考指标。Objective To investigate the relationship between serum ceruloplasmin,insulin resistance index(HOMA-IR)and Child-Pugh classification in patients with liver cirrhosis.Methods 185 patients with liver cirrhosis admitted to the hospital from July 2015 to December 2018 were selected as the study group.According to Child-Pugh classification criteria,they were divided into A-class group(58 cases),B-class group(77 cases)and C-class group(50 cases).Meanwhile,100 healthy volunteers were selected as the control group.The levels of ceruloplasmin,fasting plasma insulin(FINS),fasting plasma glucose(FPG)and insulin resistance index(HOMA-IR)in the two groups were measured.The correlation of serum ceruloplasmin and homeostasis model assessment of HOMA-IR with Child-Pugh classification was analyzed.ROC curve was used to analyze the diagnostic value of each indicator for patients with different degrees of liver cirrhosis.Results There was no statistically significant difference in FPG among the subject groups(P>0.05).FINS and HOMA-IR in the study group were significantly higher than those in the control group(P<0.05).FINS and HOMA-IR were significantly higher in Child-Pugh C-class group than those in B-class group and A-class group,and significantly higher in B-class group than in A-class group(P<0.05).Serum ceruloplasmin level in the study group was significantly lower than that in the control group(P<0.05).The level of serum ceruloplasmin:Child-Pugh C-class<B-class<A-class group,the difference is statistically significant(P<0.05).Spearman correlation analysis showed that in the study group,Child-Pugh classification was negatively correlated with the serum ceruloplasmin(r=-0.415,P<0.05),but positively correlated with HOMA-IR(r=0.510,P<0.05).ROC curve showed that areas under curve of serum ceruloplasmin and HOMA-IR in the diagnosis of Child-Pugh classification B-class and C-class were 0.644 and 0.805,respectively.The cut-off values were302.10 mg/L and 2.80,respectively.The areas under curve for diagnosing Child-Pugh classification

关 键 词：铜蓝蛋白 胰岛素抵抗 肝硬化 CHILD-PUGH分级 

分 类 号：R575.2[医药卫生—消化系统]