Ramachandran Jeyamani, Sajith K G, Priya Sophiya, Dutta Amit K, Balasubramanian K A
Trop Gastroenterol. 2014 Jan-Mar;35(1):15-20. doi: 10.7869/tg.158.
Serum cholinesterase (ChE) is an enzyme synthesised by hepatocytes and its serum levels reflect the synthetic function of liver.
In patients with cirrhosis, liver function tests, PT INR and serum ChE levels were done within a week of enrolment. We studied 178 cirrhosis patients and 154 healthy controls prospectively. Receiver operator characteristics (ROC) curve analysis was employed to compute an optimal cut-off level to distinguish these groups. Correlation between ChE activity and serum bilirubin, albumin, PT INR and MELD score (Model for End-Stage Liver Disease) was analysed.
Median serum ChE in cirrhotics was 1590 IU/L (110-8143) compared to controls 7886 IU/L (2022- 21673), p < 0.001. Serum ChE levels below 3506 had a 98.7% sensitivity and 80.3% specificity in predicting cirrhosis. Median serum ChE was higher (p < 0.001) in CC (n = 51) 4246 IU/L (680-8143) compared to DC (n = 127) 1324 IU/L (110-4550). ChE level less than 2385 IU/L had 80.1% sensitivity and 88.2% specificity in predicting DC. Follow-up levels in 25 patients showed good correlation with clinical course. The correlation coefficient between ChE and albumin was -0.67, 0.53 with PT INR and 0.59 with MELD score, (p < 0.001).
Serum ChE is an excellent biomarker of cirrhosis with good sensitivity and specificity. It shows good correlation with serum albumin, PT INR and MELD score. Since it distinguishes DC from CC well, low levels in cirrhosis may serve as a useful prognostic marker of advanced liver disease. Long-term follow-up studies are warranted to define its exact role in clinical practice.
血清胆碱酯酶（ChE）是一种由肝细胞合成的酶，其血清水平反映肝脏的合成功能。
在肝硬化患者中，于入组一周内进行肝功能检查、PT国际标准化比值（INR）及血清ChE水平检测。我们前瞻性地研究了178例肝硬化患者和154例健康对照者。采用受试者工作特征（ROC）曲线分析来计算区分这些组别的最佳临界值。分析了ChE活性与血清胆红素、白蛋白、PT INR及终末期肝病模型（MELD）评分之间的相关性。
肝硬化患者血清ChE中位数为1590 IU/L（110 - 8143），而对照组为7886 IU/L（2022 - 21673），p < 0.001。血清ChE水平低于3506时，预测肝硬化的敏感性为98.7%，特异性为80.3%。与失代偿期肝硬化（DC，n = 127）患者的1324 IU/L（110 - 4550）相比，代偿期肝硬化（CC，n = 51）患者的血清ChE中位数更高（p < 0.001），为4246 IU/L（680 - 8143）。ChE水平低于2385 IU/L时，预测DC的敏感性为80.1%，特异性为88.2%。25例患者的随访水平与临床病程显示出良好的相关性。ChE与白蛋白的相关系数为 -0.67，与PT INR为0.53，与MELD评分为0.59，（p < 0.001）。
血清ChE是肝硬化的一种优秀生物标志物，具有良好的敏感性和特异性。它与血清白蛋白、PT INR及MELD评分显示出良好的相关性。由于它能很好地区分DC与CC，肝硬化时的低水平可能作为晚期肝病的有用预后标志物。有必要进行长期随访研究以确定其在临床实践中的确切作用。
