不同Child-Pugh分级肝硬化患者糖化白蛋白的测定及其应用价值  

Measurement of glycosylated albumin and its application value in liver cirrhosis patients with different Child-Pugh classes

作　　者：高艳颖[1] 张旭[1] 李凤慧 向慧玲[1] 梁静[1] 刘华[1] 吕洪敏[1] 韩涛[1] GAO Yanying;ZHANG Xu;LI Fenghui;XIANG Huiling;LIANG Jing;LIU Hua;LYU Hongmin;HAN Tao(Department of Gastroenterology and Hepatology,Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院消化肝病科,天津300170

出　　处：《临床肝胆病杂志》2022年第2期347-351,共5页Journal of Clinical Hepatology

基　　金：天津科技重大专项与工程重大疾病防治(19ZXDBSY00030);天津市医学重点学科(专科)建设项目。

摘　　要：目的探讨不同Child-Pugh分级肝硬化患者糖化白蛋白(GA)水平及其在预测肝功能方面的应用价值。方法纳入2019年1月1日—12月31日于天津市第三中心医院住院治疗的肝硬化患者486例,其中肝硬化未合并糖尿病患者227例,肝硬化合并糖尿病患者259例。按照Child-Turcotte-Pugh(CTP)评分进行分组,测定空腹血糖、糖化血红蛋白、糖化白蛋白百分比(GA%)。非正态分布的计量资料3组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Dwass-Steel-Critchlow-Fligner检验。绘制CTP评分与GA%之间的散点图和拟合曲线,评估二者的关系,并计算cut-off值。结果肝硬化未合并糖尿病患者不同Child-Pugh分级之间GA%(χ^(2)=24.809,P<0.001)、空腹血糖(χ^(2)=11.899,P=0.003)、糖化血红蛋白(χ^(2)=13.607,P=0.001)比较差异均有统计学意义,进一步两两比较显示,Child-Pugh A级、B级肝硬化未合并糖尿病患者与C级相比,GA%差异均有统计学意义(P值均<0.05);Child-Pugh A级患者空腹血糖水平明显高于Child-Pugh B级患者(P<0.05);Child-Pugh A级患者糖化血红蛋白水平明显高于Child-Pugh B级和C级患者(P值均<0.05)。肝硬化合并糖尿病患者不同Child-Pugh分级之间GA%(χ^(2)=10.734,P=0.005)、空腹血糖(χ^(2)=16.295,P<0.001)比较差异均有统计学意义,进一步两两比较显示,Child-Pugh C级肝硬化合并糖尿病患者GA%明显低于A级和B级(P值均<0.05);Child-Pugh A级患者空腹血糖水平低于B级患者(P<0.05)。拟合曲线结果显示,肝硬化未合并糖尿病患者随着CTP评分升高,GA%升高,在评分为6.5分时GA%最高,然后开始下降,评分为11.5分时GA%最低,呈曲线关系;肝硬化合并糖尿病患者的GA%随CTP评分增加呈现先升高后降低曲线,cut-off值为8分。结论随着肝硬化病情进展,GA%出现先升高后降低的变化。不同Child-Pugh分级肝硬化患者GA水平差异明显,提示GA的降低与终末期肝硬化肝功能失代偿密切相关。Objective To investigate the level of glycosylated albumin(GA)in liver cirrhosis patients with different Child-Pugh classes and its application value in predicting liver function.Methods A total of 486 patients with liver cirrhosis who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31,2019,were enrolled,among whom 227 patients had liver cirrhosis without diabetes and 259 patients had liver cirrhosis with diabetes.The patients were divided into groups according to Child-Turcotte-Pugh(CTP)score,and fasting blood glucose,glycosylated hemoglobin,and percentage of GA(GA%)were measured.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between three groups,and the Dwass-Steel-Critchlow-Fligner test was used for further comparison between two groups.Scatter plots and fitting curves were plotted for CTP score and GA%to evaluate the association between them and calculate the cut-off value.Results For the cirrhosis patients without diabetes,there were significant differences between the patients with different Child-Pugh classes in GA%(χ^(2)=24.809,P<0.001),fasting blood glucose(χ^(2)=11.899,P=0.003),and glycosylated hemoglobin(χ^(2)=13.607,P=0.001);further pairwise comparison showed that there was a significant difference in GA%between Child-Pugh class A/B liver cirrhosis patients without diabetes and Child-Pugh class C liver cirrhosis patients(P<0.05),Child-Pugh class A patients had a significantly higher level of fasting blood glucose than Child-Pugh class B patients(P<0.05),and Child-Pugh class A patients had a significantly higher level of glycosylated hemoglobin than Child-Pugh class B/C patients(P<0.05).For the patients with liver cirrhosis and diabetes,there were significant differences between the patients with different Child-Pugh classes in GA%(χ^(2)=10.734,P=0.005)and fasting blood glucose(χ^(2)=16.295,P<0.001);further pairwise comparison showed that Child-Pugh class C liver cirrhosis patients with diabetes had a significantly lower

关 键 词：肝硬化 糖化白蛋白 诊断 

分 类 号：R575.2[医药卫生—消化系统]