【摘要】：肝性腦病(hepatic encephalopathy，HE)是肝硬化常見(jiàn)的并發(fā)癥之一，僅次于食管胃底靜脈曲張破裂出血，為嚴(yán)重的并發(fā)癥和常見(jiàn)的死亡原因。早期診斷HE可降低患者死亡率和神經(jīng)系統(tǒng)后遺癥。目前HE的診斷主要以臨床表現(xiàn)為主，依賴(lài)腦誘發(fā)電位(brain evoked protentials,BEP)、數(shù)字連接試驗(yàn)(number connecting tests,NCT)、數(shù)字符號(hào)試驗(yàn)等神經(jīng)生理和神經(jīng)心理方法以及CT、MRI等影像的異常表現(xiàn)，實(shí)驗(yàn)室檢查主要為血氨(Ammonia, NH3)增高，但較為單一，缺乏其他準(zhǔn)確、可靠的檢測(cè)指標(biāo)或方法進(jìn)行早期臨床診斷。 目的:檢測(cè)血清S100B、NH3及離子Na、Cl在HE組、非HE組及正常對(duì)照組中的含量變化，建立ROC曲線，確定血清S100B診斷HE臨界值、靈敏度及特異度，同時(shí)明確血清S100B聯(lián)合NH3診斷HE提高的靈敏度及特異度，觀察HE在入院后不同時(shí)間時(shí)血清S100B的含量變化，分析血清S100B和NH3與HE病因分型、臨床分期的關(guān)系，推測(cè)血清S100B和NH3的相關(guān)性，為HE的診斷提供新的實(shí)驗(yàn)診斷指標(biāo)及臨床應(yīng)用價(jià)值。 方法:收集2011年5月-2012年12月在吉林大學(xué)第一醫(yī)院肝病內(nèi)科住院并且臨床資料完整的97例患者的血清標(biāo)本，其中HE組52例、非HE組45例，同時(shí)收集50例正常人的血清標(biāo)本作為正常對(duì)照組。采用ELISA雙抗體夾心法檢測(cè)血清S100B的表達(dá)水平，應(yīng)用谷氨酸脫氫酶法檢測(cè)NH3濃度。采用選擇性電極方法檢測(cè)離子Na、Cl的含量。 結(jié)果: 1.血清S100B、NH3及離子Na、Cl在不同組別中的檢查結(jié)果：HE組血清S100B及NH3含量較非HE組和正常對(duì)照組明顯增高(P＜0.05)。HE組離子Na、Cl水平較非HE組和正常對(duì)照組減低(P＜0.05)。非HE組血清S100B及NH3含量均較正常對(duì)照組明顯增高(P＜0.05)。非HE組離子Na、Cl水平較非HE組和正常對(duì)照組減低(P＜0.05)。 2.血清S100B及NH3的ROC曲線：(1)血清S100B、NH3的臨界值分別為0.325ng/mL、158.5μmol/L。(2)血清S100B靈敏度(71.2%)低于NH3(84.0%)、特異度(76.9%)高于NH3(71.1%)。兩者聯(lián)合檢測(cè)的靈敏度及特異度分別為84.0%、86.7%，高于單一檢測(cè)指標(biāo)(P＜0.05)。 3.血清S100B濃度變化與HE臨床治療效果的關(guān)系：HE期血清S100B表達(dá)增高，經(jīng)過(guò)治療HE病情得到控制后，病程第3～5天、7～9天分別復(fù)查血清S100B，均較治療前明顯減低(P＜0.05)。 4.血清S100B、NH3含量和HE病因分型、臨床分期的關(guān)系：(1)不同臨床分期(I、II、III、IV期)的HE患者血清S100B和NH3含量呈Ⅰ期至Ⅳ期呈逐漸上升趨勢(shì)，差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。(2)不同病因分型(A、B、C型)的HE患者血清S100B濃度改變無(wú)明顯差異；門(mén)-體旁路性HE(B型)和慢性肝硬化性HE(C型)患者NH3濃度升高、而急性肝功能衰竭性HE(A型)患者NH3濃度正常。 5.血清S100B濃度變化與NH3含量的關(guān)系：HE組血清S100B濃度變化與NH3含量一致，二者呈正相關(guān)關(guān)系(r=0.729，P＜0.05)。 結(jié)論: 1.血清S100B在HE組高于非HE組，當(dāng)檢測(cè)水平分別高于0.325ng/mL、158.5μmol/L時(shí)，，對(duì)HE的診斷具有參考意義。 2.血清S100B含量變化與HE臨床治療效果相一致，可以為HE的臨床治療進(jìn)程提供監(jiān)測(cè)。 3.血清S100B和NH3含量與HE臨床分期相關(guān)，NH3在B型門(mén)-體旁路性、C型慢性肝硬化性HE中升高明顯，二者的檢測(cè)對(duì)HE的臨床分期與病因分型具有鑒別診斷意義。 4.血清S100B診斷的特異度均較高，NH3診斷靈敏度較高。血清S100B與NH3有一定的相關(guān)性(r=0.729，P＜0.05)，聯(lián)合檢測(cè)時(shí)對(duì)HE的診斷更有指導(dǎo)意義。
[Abstract]:Hepatic encephalopathy (HE) is one of the most common complications in liver cirrhosis. Early diagnosis of HE can reduce patient mortality and neurological sequelae. At present, HE's diagnosis is mainly based on clinical manifestation, dependence on brain evoked potential (BEP), digital connection test (NCT), digital sign test and other neurophysiological and neuropsychological methods as well as abnormal manifestations of CT, MRI and other images, and laboratory examination is mainly blood ammonia (Amminia, NH3) is increased, but is more single, lacking other accurate, reliable detection indexes or methods for early clinical diagnosis. Objective: To detect the changes of serum vitamin B, NH3 and Na, Cl in HE group, non-HE group and normal control group, establish ROC curve, determine the value, sensitivity and specificity of serum HBB in diagnosis of HE, and also make clear the sensitivity and specificity of serum S100B combined with NH3 in diagnosis of HE enhancement. The changes of serum vitamin B contents at different time after admission were observed. The relationship between serum vitamin B and NH3 and HE etiology and clinical stages was analyzed. The correlation between serum S100B and NH3 was estimated, and a new experimental diagnostic index and clinical application were provided for the diagnosis of HE. Methods: The serum samples of 97 patients were collected from May 2011 to December 2012 in the First Affiliated Hospital of Jilin University. Among them, 52 cases of HE group and 45 non-HE groups were collected, and serum samples of 50 normal subjects were collected. In the normal control group, the expression level of serum S100B was detected by ELISA double antibody sandwich method, and glutamate dehydrogenase method was used to detect the expression level. NH3 concentration. Ion Na was detected by selective electrode method. Cl鐨

本文編號(hào)：2291837