肝硬化腹水患者血清与腹水中LDH、GLU、SAAG水平与肝功能分级及预后关系  

Relationship between levels of LDH,GLU and SAAG in serum and ascites and liver function grading and prognosis in patients with liver cirrhosis complicated with ascites

作　　者：张欢 刘华柱 黄小梅 张丽丽 马欢 ZHANG Huan;LIU Huazhu;HUANG Xiaomei;ZHANG Lili;MA Huan(Department of Gastroenterology,Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Mianyang 621000,Sichuan,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院消化内科,四川绵阳621000

出　　处：《西部医学》2023年第2期277-281,共5页Medical Journal of West China

基　　金：绵阳市中心医院2020年度院级课题(2020YJ13)。

摘　　要：目的探讨肝硬化腹水患者血清与腹水中乳酸脱氢酶(LDH)、葡萄糖(GLU)、血清腹水白蛋白梯度(SAAG)水平与肝功能分级及预后的关系。方法回顾性分析我院2017年4月~2020年4月收治的90例肝硬化腹水患者的病例资料,根据肝硬化Child-Pugh分级将患者分为A组(肝功能A级,n=21)、B组(肝功能B级,n=43)、C组(肝功能C级,n=26);根据预后情况分为存活组(n=76)和死亡组(n=14)。分别比较不同肝功能分级及预后患者血清与腹水中LDH、GLU、SAAG水平;采用Logistic回归分析血清与腹水中LDH、GLU、SAAG水平与肝功能分级的关系,绘制生存曲线分析影响患者预后的关键性指标。结果C组血清与腹水LDH、GLU、SAAG水平均高于A组及B组(P<0.05),B组血清与腹水LDH、GLU、SAAG水平均高于A组(P<0.05);死亡组血清与腹水LDH、GLU及SAAG水平均高于存活组(P<0.05);ROC曲线显示,血清及腹水LDH、GLU、SAAG水平对肝功能分级的曲线下面积(AUC)分别为0.826、0.823、0.775、0.830、0.922,其中SAAG的效能最高,截断值为22.99 g/L,其敏感度、特异度分别为88.46%、87.50%;经Logistic回归分析得出,入院时SAAG水平>22.99 g/L是患者肝功能分级为C级的独立危险因素(P<0.05);入院时SAAG呈高水平(>22.99 g/L)的患者18个月生存率低于SAAG呈低水平(≤22.99 g/L)的患者(P<0.05)。结论随着血清与腹水LDH、GLU、SAAG水平的升高,肝硬化腹水患者的肝功能分级增高,预后不良发生率上升,其中SAAG水平是影响肝功能严重程度的独立危险因素,可作为评估患者预后的重要指标。Objective To explore the relationship between levels of lactate dehydrogenase(LDH),glucose(GLU)and serum ascites albumin gradient(SAAG)in serum and ascites and liver function grading and prognosis in patients with liver cirrhosis complicated with ascites.Methods The case data of 90 patients with cirrhotic ascites treated in our hospital from April 2017 to April 2020 were analyzed retrospectively.According to the Child-Pugh grading of liver cirrhosis,the patients were divided into group A(n=21,liver function grade A),group B(n=43,liver function grade B)and group C(n=26,liver function grade C).According to the prognosis,they were classified into survival group(n=76)and death group(n=14).The levels of LDH,GLU and SAAG in serum and ascites were compared among patients with different liver function grades and prognosis.Logistic regression was used to analyze the relationship between the levels of LDH,GLU,SAAG in serum and ascites and the grade of liver function,draw the survival curve and analyze the key factors affecting the prognosis of patients.Results The levels of serum and ascites LDH,GLU and SAAG in group C were higher than those in groups A and B,and the above levels in group B were higher than those in group A(P<0.05).The levels of LDH,GLU and SAAG in serum and ascites were higher in death group than those in survival group(P<0.05).ROC curve showed that the areas under the curves(AUC)of serum and ascites LDH,GLU and SAAG on liver function grading were 0.826,0.823,0.775,0.830 and 0.922 respectively,and SAAG had the highest efficiency and the cut-off was 22.99 g/L and its sensitivity and specificity were 88.46%and 87.50%.Logistic regression analysis showed that SAAG level>22.99 g/L at admission was an independent risk factor for liver function grade C(P<0.05).The 18 month survival rate of patients with high SAAG level(>22.99 g/L)at admission was lower than that of patients with low SAAG level(≤22.99 g/L)(P<0.05).Conclusion With the increase of LDH,Glu and SAAG levels in serum and ascites,the grade of liver fu

关 键 词：肝硬化 腹水 乳酸脱氢酶 葡萄糖 血清腹水白蛋白梯度 

分 类 号：R575.2[医药卫生—消化系统]