肝硬化肝性脑病危险因素及血氨、胆碱酯酶对其预测价值研究  

Study on risk factors for hepatic encephalopathy in liver cirrhosis and predictive value of blood ammonia and cholinesterase

作　　者：刘欣 李敏[1] 贾梦宇 LIU Xin;LI Min;JIA Mengyu(Department of Gastroenterology,Shangqiu First People′s Hospital,Shangqiu,Henan 476005,China)

机构地区：[1]商丘市第一人民医院消化内科,河南商丘476005

出　　处：《现代医药卫生》2024年第24期4256-4260,4265,共6页Journal of Modern Medicine & Health

摘　　要：目的分析肝硬化患者发生肝性脑病的危险因素,探讨血氨、胆碱酯酶对其的预测价值,以制定对应预防对策,改善患者预后。方法回顾性选取该院于2019年8月至2023年8月收治的肝硬化患者772例作为研究对象,以是否发生肝性脑病为依据,将其分为肝性脑病组(85例)及无肝性脑病组(687例)。统计2组患者临床基线资料,对其进行单因素、多因素分析,以筛选出肝硬化患者发生肝性脑病的相关危险因素,并分析不同分期肝硬化肝性脑病患者血氨、胆碱酯酶的变化。绘制受试者工作特征曲线分析血氨、胆碱酯酶单独及联合检测对肝硬化患者发生肝性脑病的预测价值。结果单因素及多因素losgistic回归模型分析结果显示,有肝性脑病史、经颈静脉肝内门腔静脉分流术(TIPS)、碱中毒、高血清胆红素(TBiL)水平、低血清白蛋白(Alb)水平、高终末期肝病模型(MELD)评分、低血钠水平、高蛋白饮食均为肝硬化患者发生肝性脑病的独立危险因素(比值比=1.070、1.067、1.087、1.096、1.129、1.133、1.075、1.089,P<0.05)。与无肝性脑病组相比,肝性脑病组患者血氨水平更高,胆碱酯酶水平更低;Ⅰ~Ⅳ期肝性脑病患者血氨水平呈逐渐升高趋势,胆碱酯酶水平则呈逐渐降低趋势;联合检测的曲线下面积高于血氨、胆碱酯酶单独检测,差异均有统计学意义(P<0.05)。结论有肝性脑病史、TIPS、碱中毒、高MELD评分、高血清TBiL水平、低血清Alb水平、低血钠水平、高蛋白饮食均为肝硬化患者发生肝性脑病的独立危险因素,且血氨水平与肝性脑病分期呈正相关,胆碱酯酶水平与肝性脑病分期呈负相关,血氨、胆碱酯酶两者联合检测对肝硬化患者发生肝性脑病的早期诊断具有较高的临床价值。Objective To analyze the risk factors for hepatic encephalopathy(HE)in patients with liver cirrhosis,explore the predictive value of blood ammonia and cholinesterase for HE,and develop corresponding preventive strategies to improve patient prognosis.Methods A retrospective analysis was conducted on 772 patients with liver cirrhosis admitted to our hospital from August 2019 to August 2023.Based on the occurrence of HE,the patients were divided into the HE group(85 patients)and the non-HE group(687 patients).The clinical baseline data of the two groups were collected,and univariate and multivariate analyses were performed to screen for relevant risk factors for HE in patients with liver cirrhosis.Changes in blood ammonia and cholinesterase levels were analyzed in patients with liver cirrhosis and HE at different stages.Receiver operating characteristic curves were plotted to analyze the predictive value of blood ammonia,cholinesterase,and their combined detection for HE in patients with liver cirrhosis.Results The results of univariate and multivariate logistic regression model analysis showed that a history of HE,transjugular intrahepatic portosystemic shunt(TIPS),alkalosis,high total bilirubin(TBiL)level,low serum albumin(Alb)level,high Model for End-Stage Liver Disease(MELD)score,low blood sodium level,and high-protein diet were independent risk factors for HE in patients with liver cirrhosis(odds ratios=1.070,1.067,1.087,1.096,1.129,1.133,1.075,1.089,respectively;P<0.05).Compared with the non-HE group,patients in the HE group had higher blood ammonia levels and lower cholinesterase levels.Blood ammonia levels gradually increased,while cholinesterase levels gradually decreased in patients with HE at stages I to IV.The area under the curve for combined detection was higher than that for blood ammonia and cholinesterase alone,with statistically significant differences(P<0.05).Conclusion A history of HE,TIPS,alkalosis,high MELD score,high serum TBiL level,low serum Alb level,low blood sodium level,and high-protein

关 键 词：肝硬化 肝性脑病 危险因素 血氨 胆碱酯酶 预测价值 

分 类 号：R473.5[医药卫生—护理学]