前白蛋白及纤维蛋白原水平与代偿期肝硬化食管静脉曲张发生的关系  

Correlation between the levels of prealbumin and fibrinogen and the occurrence of esophageal varices in compensated liver cirrhosis

作　　者：孙玉 秦维 王丹 郑艳丽 霍玉玲 Sun Yu;Qin Wei;Wang Dan;Zheng Yanli;Huo Yuling(Department of Liver Diseases,Baoding People’s Hospital,Hebei Baoding 071000,China)

机构地区：[1]保定市人民医院肝病科,河北保定071000

出　　处：《中国肝脏病杂志（电子版）》2024年第2期7-12,共6页Chinese Journal of Liver Diseases：Electronic Version

基　　金：保定市科技局项目(2141ZF287)。

摘　　要：目的观察代偿期肝硬化患者血清前白蛋白(prealbumin,PA)及血浆纤维蛋白原(fibrinogen,FIB)水平,分析其与代偿期肝硬化患者发生食管静脉曲张的关系。方法采取前瞻性研究,选择2021年11月至2022年6月于保定市人民医院接受治疗的100例代偿期肝硬化患者作为研究对象。所有患者入院时均接受胃镜检查,根据食管静脉曲张发生情况分为食管静脉曲张组和无食管静脉曲张组。统计患者基线资料并检测血清PA和血浆FIB水平,采用Logistic回归分析代偿期肝硬化食管静脉曲张的影响因素,采用受试者工作特征(receiver operator characteristic,ROC)曲线评估PA、FIB水平对代偿期肝硬化患者食管静脉曲张发生的预测价值,采用限制性立方样条法分析PA及FIB水平与代偿期肝硬化食管静脉曲张发生的剂量反应关系。结果100例代偿期肝硬化患者经胃镜检查,确诊食管静脉曲张43例,发生率43.00%;食管静脉曲张组患者Child-Pugh C级占比高于无食管静脉曲张组[39.53%(17/43)比17.54%(10/57)],入院时血清PA[(79.18±18.76)mg/L比(101.06±21.57)mg/L]、血浆FIB水平[(1.52±0.42)g/L比(2.15±0.83)g/L]低于无食管静脉曲张组,差异均有统计学意义(P均<0.05)。Logistic回归分析表明Child-Pugh C级是代偿期肝硬化患者食管静脉曲张发生的危险因素(OR=6.518,95%CI:1.518~27.981,P=0.012);入院时血清PA、血浆FIB高表达是保护因素(OR=0.934,95%CI:0.905~0.964,P<0.001;OR=0.109,95%CI:0.034~0.344,P<0.001)。PA、FIB值及二者联合预测代偿期肝硬化患者食管静脉曲张发生的ROC曲线下面积分别为0.792、0.756、0.857,联合预测的曲线下面积显著高于FIB单独预测(z=1.683,P=0.046),与单独PA比较差异无统计学意义(z=1.113,P=0.266)。限制性立方样条法结果显示,PA、FIB水平与代偿期肝硬化患者食管静脉曲张发生的关联强度呈线性剂量反应关系(P<0.05),PA、FIB水平与代偿期肝硬化患者食管静脉曲张发生呈负相Objective To observe the levels of serum prealbumin(PA)and plasma fibrinogen(FIB)in patients with compensated liver cirrhosis,and analyze the relationship between PA and FIB and the occurrence of esophageal varices in patients with compensated liver cirrhosis.Methods In a prospective study,100 patients with compensated liver cirrhosis who were treated in Baoding People’s Hospital from November 2021 to June 2022 were selected as the study subjects.All patients received gastroscopy at admission and divided into esophageal varices group and non-esophageal varices group according to the occurrence of esophageal varices.The baseline data was counted and serum PA and plasma FIB levels were measured.Logistic regression analysis was used to analyze the influencing factors of esophageal varices in patients with compensated cirrhosis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of PA and FIB levels on the occurrence of esophageal varices in patients with compensated cirrhosis.The dose-response relationship between PA and FIB levels and the occurrence of esophageal varices in compensated cirrhosis was analyzed by restricted cubic spline method.Results Total of 43 cases of esophageal varices were diagnosed by gastroscopy in 100 patients with compensated liver cirrhosis,the incidence was 43.00%.The proportion of Child-Pugh grade C in esophageal varices group was higher than that in non-esophageal varices group[39.53%(17/43)vs.17.54%(10/57)],and the levels of serum PA[(79.18±18.76)mg/L vs.(101.06±21.57)mg/L]and plasma FIB[(1.52±0.42)g/L vs.(2.15±0.83)g/L]at admission were lower than those in non-esophageal varices group,the differences were statistically significant(all P<0.05).Logistic regression analysis showed that Child-Pugh grade C was a risk factor for esophageal varices in patients with compensated cirrhosis(OR=6.518,95%CI:1.518~27.981,P=0.012),while the high expression of serum PA and plasma FIB on admission were protective factors(OR=0.934,95%CI:0.905~0.964,P<0.001;OR

关 键 词：肝硬化 食管静脉曲张 代偿期 前白蛋白 纤维蛋白原 

分 类 号：R575.2[医药卫生—消化系统]