肝炎肝硬化患者相关理化指标特征及意义

摘要

目的：回顾性分析肝炎后肝硬化患者的相关理化检测指标，探讨其在 Child-pugh 不同分级及代偿、失代偿期不同分期中的特征和临床意义。方法：收集厦门市中医院6个月内全部符合纳入标准的肝炎肝硬化患者共87例。分别分析肝功能不同分期及不同 Child 分级患者的血清肝功能（血清白蛋白、球蛋白、胆红素、胆碱酯酶、碱性磷酸酶、转氨酶、转肽酶、总胆汁酸）、凝血（凝血酶原时间、凝血酶原活动度）及血小板计数等，2组比较采用 t 检验，多组比较采用方差分析，观察不同组间患者检测指标的特征及变化趋势。结果：乙肝硬化代偿期和失代偿期患者相比，失代偿期患者年龄及 Child 评分显著高于代偿期患者，其 TBIL、ALP、GGT、TBA、INR、及 PT 检测值亦明显高于代偿期患者（P ＜0.01），而 ALB、PLT 及 CHE值明显低于代偿期组（P ＜0.01），而 GLB 及 ALT、AST、AFP 等指标间差异无统计学意义（P ＞0.05）；在 ChildA、B、C 3组患者中，ALB、PLT、CHE 三项检测值随着 Child 分级的增加而降低。而 TBIL、ALP、TBA、INR 及 PT 则随着 Child 分级的增加而升高。GLB、ALT、AST、AFP 等指标差异无统计学意义（P ＞0.05）。结论：肝炎后肝硬化患者血液中 ALB、TBIL、ALP、TBA、CHE、PT、INR 及 PLT 等检测指标与疾病严重程度相关，可以之评价肝脏合成功能并分析判断疾病预后；而 GLB、ALT、AST、GGT 等反应肝细胞炎症的指标以及 AFP 变化则与肝硬化严重程度不一定平行。%Objective:By retrospective analysis of related biochemical measurements of patients with liver cirrhosis induced by hepatitis,their characteristics and clinical significance in different stage of Child -pugh,compensated or decompensated period were discussed.Methods:Total 87 patients with liver cirrhosis induced by hepatitis were collected with the according standard in a fixed period of time(from 1 to 6 month,2014).Patients’liver function(ALB,GLB,BIL,CHE,ALP,ALT,GGT,TBA),cruor (PT,PTA),BPC and PLT etc.in different grade and different Child stage were analyzed by T -test or Analysis of Variance in or-der to observe their characteristics and trend respectively.Results:Compared to the patients with compensatory stage,the age,Child score,and values of TBIL,ALP,TBA,INR and PT of patients in decompensatory stage was significantly higher(P <0.01),in the other hand,the values of ALB,PLT and CHE in decompensatory stage are lower than in compensatory stage(P <0.01).However there are no statistical difference in the index of GLB,ALT,AST,AFP(P >0.05).In the three group patients of Child A,B,C,the values of ALB,PLT and CHE gradually decreased with the increase of child classification,but TBIL,ALP,TBA,INR and PT in-creased with the increase of child classification,and there were no statistical difference in the index of GLB,ALT,AST,GGT,AFP (P >0.05).Conclusion:In the serum of patients with liver cirrhosis induced by hepatitis,the detection index of ALB,TBIL,ALP, TBA,CHE,PT,INR,PLT were associated with the severity of disease,which can be used to evaluate liver function and analyze dis-ease prognosis.But the index of liver inflammation such as GLB,ALT,AST and changes of AFP were not accordance with the sever-ity of liver cirrhosis.