摘要
目的 探讨血清层粘连蛋白(laminin,LN)、蛋白电泳(protein electrophoresis,SPE)与肝硬化严重程度的相关性及对合并轻微型肝性脑病的预测价值.方法 选取青海省第四人民医院2020年1月至2024年1月收治的200例肝硬化患者作为研究对象,根据肝硬化Child-pugh分级标准分为A级组(n=46),B级组(n=90),C级组(n=64).对比上述3组患者LN、SPE表达水平,应用Spearman相关性分析法分析LN、SPE与肝硬化严重程度的相关性.随后将200例肝硬化患者依照是否合并轻微型肝性脑病分为肝性脑病组(n=35)与非肝性脑病组(n=165),对比分析2组患者的一般及临床资料,LN及SPE表达水平,Logistics回归模型分析肝硬化合并轻微型肝性脑病的影响因素,建立受试者工作特征(receiver operating characteristic,ROC)曲线分析LN、SPE对合并轻微型肝性脑病的预测价值.结果 A级组、B级组及C级组患者间血清LN、SPE水平比较,差异均具有统计学意义,C级组患者γ-球蛋白、α1-球蛋白及LN水平均高于B级组与A级组患者,而β-球蛋白、α2-球蛋白及白蛋白水平均低于B级组与A级组患者(P均<0.05);Spearman相关分析结果显示:γ-球蛋白、α1-球蛋白及LN水平与肝硬化严重程度呈正相关,β-球蛋白、α2-球蛋白及白蛋白水平与肝硬化严重程度呈呈负相关(P均<0.05).肝性脑病组与非肝性脑病组患者Child-pugh分级、合并肝肾综合征、合并肝硬化腹水、合并电解质紊乱、合并感染、血氨及总胆红素水平对比差异均具有统计学意义(P均<0.05);肝性脑病组与非肝性脑病组α1-球蛋白及白蛋白相关血清SPE水平对比,差异均无统计学意义(P均>0.05),而γ-球蛋白、β-球蛋白、α2-球蛋白相关血清SPE及LN水平对比差异均具有统计学意义(P均<0.05);合并电解质紊乱、合并感染、γ-球蛋白、β-球蛋白、α2-球蛋白相关血清SPE及LN是肝硬化轻微型肝性脑病发生的危险因素(P均>0.05);ROC曲线分析LN、SPE对肝硬化合并轻微型肝性脑病的预测价值,LN联合SPE对肝硬化合并轻微型肝性脑病的预测灵敏度为93.54％,特异度为85.45％,联合预测明显高于单一诊断(P<0.05).结论 血清LN及SPE水平与肝硬化严重程度密切相关,且除合并电解质紊乱、合并感染情况可增加肝硬化轻微型肝性脑病的发生风险外,通过血清LN及SPE水平可早期预测轻微型肝性脑病的发生.
Abstract
Objective To explore the correlation between serum laminin (LN),protein electrophoresis (SPE) and the severity of liver cirrhosis,and their predictive value for mild hepatic encephalopathy. Method Two hundred patients with liver cirrhosis admitted to our hospital from January 2020 to January 2024 were selected as the research subjects. The severity of liver cirrhosis was determined by Child Pugh grading for all patients,with 46 cases classified as A,90 cases classified as B,and 64 cases classified as C. Compare the expression levels of serum laminin and SPE in patients with different Child Pugh grades,and use Spearman correlation analysis to analyze the correlation between laminin,SPE and the severity of liver cirrhosis. Subsequently,200 patients with cirrhosis were divided into two groups based on whether they had mild hepatic encephalopathy or not,namely the hepatic encephalopathy group (n=35) and the non hepatic encephalopathy group (n=165). Compared with the general clinical data,the expression level of LN and SPE,logistics regression model analyzed the influencing factors of cirrhosis with mild hepatic encephalopathy,and established ROC curve to analyze the predictive value of LN and SPE with mild hepatic encephalopathy. Result The comparison of serum LN and SPE levels among patients in Class A,Class B,and Class C groups showed statistically significant differences. The levels of gamma globulin,α 1-globulin,and LN in patients with grade C were higher than those in patients with grade B and grade A,while the levels of beta globulin,α 2-globulin,and albumin in patients with grade C were lower than those in patients with grade B and grade A (P<0.05);The Spearman correlation analysis results showed that γ-globulin,α 1-globulin,and LN were positively correlated with the severity of liver cirrhosis,while β-globulin,α 2-globulin,and albumin were negatively correlated with the severity of liver cirrhosis (P<0.05);There were significant differences (P<0.05) in Child Pugh grading,hepatorenal syndrome,ascites,electrolyte imbalance,infection,blood ammonia,and total bilirubin levels between patients with hepatic encephalopathy and those without hepatic encephalopathy;There was no significant difference in the levels of α 1-globulin and albumin related serum SPE between the hepatic encephalopathy group and the non hepatic encephalopathy group (P>0.05),while there were significant differences in the levels of γ-globulin,β-globulin,α 2-globulin related serum SPE and LN between the hepatic encephalopathy group and the non hepatic encephalopathy group (P<0.05);The combined electrolyte disorder,co-infection,γ-globulin,β-globulin,α2-globulin related serum SPE and LN were the influencing factors for the occurrence of mild hepatic encephalopathy with cirrhosis (P<0.05);the prediction value of LN and SPE on cirrhosis with mild hepatic encephalopathy was 93.54％,85.45％,and the combined prediction was significantly higher than the single diagnosis (P<0.05). Conclusion Serum LN and SPE are closely related to the severity of liver cirrhosis,and in addition to the increased risk of mild hepatic encephalopathy caused by electrolyte disorders and co infection,serum LN and SPE can predict the occurrence of mild hepatic encephalopathy early.
基金项目
青海省卫健委科研项目(2023-wjzdx-72)
维普
万方数据