肝功能衰竭患者血清磷和甲胎蛋白检测的临床意义

摘要

目的 回顾性分析血清磷和甲胎蛋白(AFP)与肝功能衰竭患者病情和预后的关系.方法 收集202例肝功能衰竭患者的性别、年龄、AFP、国际标准化比值(INR)和生物化学指标.采用Spearman等级相关分析血清磷和AFP与血TBil、INR、白蛋白、ALT、肌酐的相关性.单因素Logistic回归分析血清磷和AFP与肝功能衰竭并发上消化道出血、肝性脑病、肺部感染和原发性细菌性腹膜炎的相关性;多因素Logistic回归分析肝功能衰竭患者4周内死亡的危险因素.结果 肝功能衰竭患者血清磷均值低于正常参考值,血清磷与TBil和AFP呈负相关(r值分别为-0.254、-0.271,均P＜0.05),与血清肌酐呈正相关(r=0.312,P＜0.05).AFP均值高于正常参考值,AFP与INR呈负相关(r=-0.159,P＜0.05).血清磷和AFP与肝功能衰竭并发上消化道出血、肝性脑病、肺部感染和原发性细菌性腹膜炎无明显相关性.趋势分析显示,血清磷与终末期肝病模型(MELD)评分转归趋势有关(P＜0.05),而AFP与MELD评分转归趋势无关(P＞0.05);多因素Logistic回归分析显示,血清磷、AFP、MELD评分、上消化道出血、肝性脑病、肺部感染和原发性细菌性腹膜炎对死亡有影响.结论 血清磷和AFP与肝功能衰竭病情相关,是肝功能衰竭患者死亡的影响因素.%Objective To retrospectively study the relationship between the serum level of phosphorus and α-fetoprotein (AFP) with the condition and prognosis of the patients with liver failure.Methods The sex,age,AFP,international normalized ratio (INR) and the biochemical indexes of 202 patients with liver failure were collected.The relationships of phosphorus and AFP with total bilirubin (TBil),INR,albumin,alanine aminotransferase (ALT) and creatinine (Cr) were analyzed by Spearman rank correlation.The relationships of phosphorus and AFP with liver failure complications including upper gastrointestinal bleeding,hepatic encephalopathy,pulmonary infection and primary bacterial peritonitis were analyzed by univariate Logistic regression.Multivariate Logistic regression was used to analyze the risk factors of 4-week death in patients with liver failure.Results The level of phosphorus in patients with liver failure was lower than the normal reference value.Serum level of phosphorus was both negatively correlated with TBil and AFP (r=-0.254,P＜0.05; r=-0.271,P＜0.05,respectively),but positively correlated with serum Cr (r=0.312,P＜0.05).Conversely,the level of AFP in patients with liver failure was higher than the normal reference value and was negatively correlated with INR (r=-0.159,P＜ 0.05).Serum levels of phosphorus and AFP had no correlations with liver failure complications,such as upper gastrointestinal bleeding,hepatic encephalopathy,pulmonary infection and primary bacterial peritonitis.By trend analysis,phosphorus was associated with model for end-age liver disease (MELD) score (P＜0.05).However,there was no association between AFP and MELD score (P＞0.05).In addition,the analysis of multivariate Logistic regression showed that phosphorus,AFP,MELD,upper gastrointestinal bleeding,hepatic encephalopathy,pulmonary infection and primary bacterial peritonitis were associated with death of patients with liver failure.Conclusion Phosphorus and AFP are correlated with the outcome of patients with liver failure and are the risk factors of death in patients with liver failure.