【摘要】：目的:1.了解血清膽堿酯酶(Cholinesterase,CHE)對肝損害及肝臟儲備功能的評價作用;2.了解血清膽堿酯酶與終末期肝病模型(Model for end-stage of liver disease,MELD)之間的相關(guān)性;3.分析血清膽堿酯酶、終末期肝病模型評分對乙肝肝硬化失代償期患者短期預(yù)后的預(yù)測價值。方法:1.收集2015年11月至2016年7月期間入住江蘇省蘇北人民醫(yī)院肝脾內(nèi)科病歷資料和隨訪結(jié)果完整的失代償期乙肝肝硬化患者80例,分析其血清CHE水平,并與30例健康體檢者的血清CHE水平進行對比研究。2.分析80例失代償期乙肝肝硬化患者CHE水平與MELD評分的相關(guān)性。3.對80例患者進行預(yù)后隨訪研究,根據(jù)隨訪3個月的存活情況分為存活組和死亡組,通過繪制血清膽堿酯酶及MELD評分系統(tǒng)3個月預(yù)后的受試者工作特征曲線(receiver operating characteristic curve,ROC曲線)評價血清CHE、MELD評分對失代償期乙肝肝硬化患者3個月預(yù)后的預(yù)測能力。4.利用ROC曲線截斷值建立Kaplan-Meier生存曲線,同時分析血清CHE聯(lián)合MELD評分對患者預(yù)后評估的價值。結(jié)果:1.失代償期乙肝肝硬化患者組血清CHE值平均為(3.23±1.73)KU/L,較正常對照組(5.64±2.13)KU/L 明顯降低(P0.01)。2.失代償期乙肝肝硬化患者隨著MELD評分升高,膽堿酯酶水平降低,經(jīng)過pearson相關(guān)分析可知,r=-0.423,P=0.00,MELD評分與血清CHE呈明顯的負相關(guān)。3.根據(jù)ROC曲線可知,CHE、MELD的截斷值分別為2.09KU/L、28.5,使用MELD評分≥28.5來判斷乙肝肝硬化失代償期患者的3個月是否出現(xiàn)死亡的靈敏度和特異度分別為100%和82.6%,使用血清CHE值≤2.09來判斷乙肝肝硬化失代償期患者的3個月是否出現(xiàn)死亡的靈敏度和特異度分別為81.8%和85.5%,兩種判斷方法均有良好的靈敏度、特異度。4.通過截斷值MELD=28.5以及CHE=2.09為界限,將80例患者分為四組,建立Kaplan-Meier生存曲線,結(jié)果顯示第四組人群即MELD評分≥28.5且CHE≤2.09KU/L的乙肝肝硬化失代償期患者死亡風(fēng)險最大。結(jié)論:1.患者組的血清膽堿酯酶明顯低于健康者組,血清膽堿酯酶是反映肝臟損害理想的指標(biāo)。2.血清膽堿酯酶與MELD評分呈負相關(guān),血清膽堿酯酶能夠準(zhǔn)確的反映肝功能儲備功能及肝臟損害程度。3.綜合MELD評分、血清CHE值更能準(zhǔn)確判斷乙肝肝硬化失代償期患者短期預(yù)后,為患者個體化治療方案提供臨床依據(jù),為建立新型終末期肝病模型提供思路。
[Abstract]:Objective: 1. To investigate the effect of serum cholinesterase (Cholinesterase,CHE) on liver damage and liver reserve function. To investigate the correlation between serum cholinesterase and end-stage liver disease model (Model for end-stage of liver disease,MELD. To analyze the predictive value of serum cholinesterase and end-stage liver disease model score for short-term prognosis of patients with decompensated hepatitis B liver cirrhosis. Method: 1. The medical records and follow-up results of 80 patients with decompensated hepatitis B liver cirrhosis admitted to Jiangsu Subei people's Hospital from November 2015 to July 2016 were collected and their serum CHE levels were analyzed and compared with those of 30 healthy subjects. 2. The correlation between CHE level and MELD score in 80 patients with decompensated hepatitis B liver cirrhosis was analyzed. 80 patients were followed up for prognosis. According to the survival of 3 months, they were divided into survival group and death group. The working characteristic curve (receiver operating characteristic curve,ROC curve of serum cholinesterase and MELD scoring system for 3 months was drawn to evaluate the ability of serum CHE,MELD score to predict the prognosis of patients with decompensated hepatitis B liver cirrhosis at 3 months. The survival curve of Kaplan-Meier was established by using the cut-off value of ROC curve, and the value of serum CHE combined with MELD score in evaluating the prognosis of patients was analyzed. Result: 1. The mean serum che value of decompensated hepatitis B cirrhotic patients was (3.23 鹵1.73) KU/L, which was significantly lower than that of the normal control group (5.64 鹵2.13) KU/L (P 0.01). The level of cholinesterase decreased with the increase of MELD score in patients with decompensated hepatitis B liver cirrhosis. through pearson correlation analysis, it was found that there was a significant negative correlation between meld score and serum CHE. According to the ROC curve, the cut-off values of CHE,MELD were 2.09 KU and 28.5, respectively. the sensitivity and specificity of using MELD score 鈮，

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