前白蛋白、胆碱酯酶及视黄醇结合蛋白在肝硬化合并肝性脑病中的临床诊断意义

Clinical diagnostic significance of prealbumin, cholinesterase and retinol binding protein in liver cirrhosis combined with encephalopathy.

作者信息

Tan L, Meng Y, Zeng T, Wang Q, Long T, Wu S, Guan X, Fu H, Zheng W, Tian Y, Chen J, Yu J, Wu Y, Li H, Cao L

机构信息

a Department of Clinical Laboratory Science, Jiangxi Province Key Laboratory of Laboratory Medicine , the Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , China.

b School of Public Health , Nanchang University , Nanchang , Jiangxi , China.

出版信息

Br J Biomed Sci. 2019 Jan;76(1):24-28. doi: 10.1080/09674845.2018.1523673. Epub 2018 Nov 5.

DOI:10.1080/09674845.2018.1523673

PMID:30392460

Abstract

OBJECTIVE

Hepatic encephalopathy is a common consequence of liver cirrhosis, but diagnosis can be difficult as it is based on clinical criteria alone. We hypothesised that serum prealbumin, cholinesterase and retinol binding protein (RBP) can help support the diagnosis of hepatic encephalopathy.

METHODS

We enrolled 306 cirrhotic patients (110 with encephalopathy), 100 chronic hepatitis B patients and 50 healthy controls, measuring routine liver function tests (ALT, AST, GGT, ALP, and bilirubin), albumin, prothrombin time, prealbumin, cholinesterase and RBP by routine methods. Logistic regression analysis and areas under the receiver operating characteristic curves (AUCs) were used to find predictive factors for hepatic encephalopathy.

RESULTS

There were differences in all laboratory indices between the three groups (all p < 0.001). In univariate analysis, albumin, prothrombin time, prealbumin, cholinesterase and RBP were significantly altered in those with encephalopathy (p < 0.01), but only prealbumin, cholinesterase and RBP levels were significant predictors in multivariate analysis, and each was linked to the severity of liver fibrosis defined by the Child-Pugh score (all p < 0.001). The AUCs (95% CI) of prealbumin, cholinesterase and RBP for diagnosing liver cirrhosis with hepatic encephalopathy were comparable at 0.85 (81-90), 0.81 (0.76-0.85) and 0.81 (0.76-0.86), respectively (all p < 0.01).

CONCLUSIONS

Serum prealbumin, cholinesterase and RBP levels are of potential clinical value in diagnosis of liver cirrhosis complicated by encephalopathy.

摘要

目的

肝性脑病是肝硬化的常见并发症，但由于其诊断仅基于临床标准，故诊断可能存在困难。我们推测血清前白蛋白、胆碱酯酶和视黄醇结合蛋白（RBP）有助于支持肝性脑病的诊断。

方法

我们纳入了306例肝硬化患者（110例患有脑病）、100例慢性乙型肝炎患者和50例健康对照者，采用常规方法检测常规肝功能指标（谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、碱性磷酸酶和胆红素）、白蛋白、凝血酶原时间、前白蛋白、胆碱酯酶和RBP。采用逻辑回归分析和受试者工作特征曲线下面积（AUC）来寻找肝性脑病的预测因素。

结果

三组之间所有实验室指标均存在差异（均P<0.001）。单因素分析中，脑病患者的白蛋白、凝血酶原时间、前白蛋白、胆碱酯酶和RBP均有显著改变（P<0.01），但多因素分析中只有前白蛋白、胆碱酯酶和RBP水平是显著的预测因素，且每一项都与根据Child-Pugh评分定义的肝纤维化严重程度相关（均P<0.001）。前白蛋白、胆碱酯酶和RBP诊断肝硬化合并肝性脑病的AUC（95%CI）分别为0.85（81-90）、0.81（0.76-0.85）和0.81（0.76-0.86），三者相当（均P<0.01）。