胆红素、血氨在肝硬化合并肝性脑病预后预测中的应用  

Application of serum bilirubin and blood ammonia in predicting the prognosis of liver cirrhosis complicated with the hepatic encephalopathy

作　　者：路丽芳 崔虎啸 王坤铎 艾艳琴 LU Lifang;CUI Huxiao;WANG Kunduo;AI Yanqin(Department of Infection,Xuchang Central Hospital,Xuchang 461000,China)

机构地区：[1]许昌市中心医院感染科,许昌461000

出　　处：《华夏医学》2025年第1期113-118,共6页Acta Medicinae Sinica

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191396)。

摘　　要：目的探究血清胆红素(BIL)、血氨水平在肝硬化合并肝性脑病(HE)患者中的应用价值。方法选取120例肝硬化患者为对象,根据是否合并HE分为HE组(n=67)和对照组(n=53),根据入院时病情严重程度将HE组患者分为轻微型肝性脑病(MHE)组(n=45)和明显肝性脑病(OHE)组(n=22),根据预后将HE患者分为预后良好组(n=50)和预后不良组(n=17)。比较各组肝硬化分级、BIL及血氨水平,受试者工作特征(ROC)曲线分析BIL和血氨对HE患者预后的预测价值。结果HE组肝硬化Child C级、BIL和血氨水平高于对照组,差异有统计学意义(P<0.05);MHE组肝硬化Child C级、BIL和血氨水平低于OHE组(P<0.05);预后良好组BIL和血氨水平低于预后不良组(P<0.05)。BIL、血氨及其联合检测预测HE患者预后的曲线下面积(AUC)分别为0.772、0.794、0.839。结论肝硬化合并HE患者存在明显的血清BIL、血氨水平升高现象;血清BIL、血氨水平与HE患者病情严重程度及预后有关,二者联合检测可提高对HE患者预后的预测价值。Objective To explore the application value of serum bilirubin(BIL)and blood ammonia levels in patients with the liver cirrhosis complicated with the hepatic encephalopathy(HE).Methods 120 patients with the liver cirrhosis were selected.According to the presence of HE,the patients were divided into the HE group(n=67)and the control group.According to the severity of the condition at admission,the patients with HE were divided into the mild mini HE(MHE)group(n=45)and the obvious HE(OHE)group(n=22).According to the prognosis,the patients with HE were divided into the good prognosis group(n=50)and the poor prognosis group(n=17).The liver cirrhosis grade,serum BIL and blood ammonia levels in each group were compared,and the predictive value of serum BIL and blood ammonia levels for the prognosis of patients with HE was analyzed by the receiver operating characteristic(ROC)curve.Results The levels of Child C,serum BIL and blood ammonia levels in HE group were significantly higher than those in control group,which the difference is statistically significant(P<0.05).The levels of Child C,serun BIL and blood ammonia levels in MHE group were significantly lower than those in OHE group(P<0.05).Serun BIL and blood ammonia levels in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05).The areas under the curve(AUC)for predicting the prognosis of HE patients using serun BIL and blood ammonia levels,and their combined detection were 0.772,0.794,and 0.839,respectively.Conclusion The serum BIL and blood ammonia levels in patients with the liver cirrhosis complicated by with the hepatic encephalopathy are significantly elevated.Serum BIL and blood ammonia levels are related to the severity and prognosis of the patients with HE.The combined detection of serun BIL and blood ammonia improve the predictive value of prognosis in the patients with HE.

关 键 词：肝硬化 肝性脑病 胆红素 血氨 病情程度 预后 

分 类 号：R575.2[医药卫生—消化系统]