乙型肝炎相关慢加急性肝衰竭患者血清碱性磷酸酶的变化及意义

肝脏 ›› 2019, Vol. 24 ›› Issue (11): 1234-1236.

乙型肝炎相关慢加急性肝衰竭患者血清碱性磷酸酶的变化及意义

顾静, 陈祖涛, 孙蔚, 甘建和

215006 苏州大学附属第一医院感染科

收稿日期:2019-08-17 出版日期:2019-11-25 发布日期:2020-04-01
通讯作者: 甘建和,Email:ganjianhe@aliyun.com
基金资助:
国家科技部“十三五”重大专项课题(2017ZX10203201002-002)。

Changes of serum alkaline phosphatase in patients with HBV-related acute-on-chronic liver failure and its significance

GU Jing, CHEN Zu-tao, SUN Wei, GAN Jian-he

Department of Infectious Diseases, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China

Received:2019-08-17 Online:2019-11-25 Published:2020-04-01
Contact: GAN Jian-he, Email: ganjianhe@aliyun.com

摘要/Abstract

摘要： 目的探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者血清碱性磷酸酶(ALP)的变化及意义。方法收集2015年1月至2018年12月在苏州大学附属第一医院感染病科住院的92例HBV-ACLF患者,40例慢性乙型肝炎(CHB)患者及34名健康对照者,比较3组人群的外周血ALP水平差异。观察HBV-ACLF患者存活组和死亡组入院时和入院后1周ALP水平的动态变化;比较HBV-ACLF患者ALP上升组和ALP下降组存活率的差异;分析HBV-ACLF患者入院后1周ALP的上升值与前白蛋白(PAB)和终末期肝病评分(model for end stage liver disease,MELD)的相关性。结果 HBV-ACLF组、CHB组、健康对照组ALP水平分别为(421.37±136.35)、(116.14±38.62)和(104.23±35.19)U/L,3组间差异有统计学意义(F=77.193,P<0.05),HBV-ACLF组ALP水平较CHB组及健康对照组明显升高(q值分别为3.704、4.548,均P<0.05)。HBV-ACLF患者存活组ALP(86.17±19.36)U/L明显高于死亡组(29.46±8.21)U/L,差异有统计学意义(t=4.78,P<0.05)。HBV-ACLF患者ALP上升组存活率73.08%(38/52)高于ALP下降组32.5%(13/40),差异有统计学意义(χ²=33.48,P<0.05)。HBV-ACLF患者入院后1周MELD评分为(35.63±5.81)分,PAB水平为(73.57±32.69)g/L,入院后1周ALP上升值与MELD评分呈负相关,与PAB呈正相关(r分别为-0.725、0.763,均P<0.05)。结论 HBV-ACLF患者外周血ALP持续升高是患者预后良好的标志。

关键词: 肝衰竭, 乙型肝炎病毒, 碱性磷酸酶, 前白蛋白, 终末期肝病评分

Abstract: Objective To investigate the changes of serum alkaline phosphatase (ALP) in patients with hepatitis B virus (HBV)- related acute-on-chronic liver failure (HBV-ACLF) and its significance.Methods A total of 92 HBV-ACLF patients hospitalized in our hospital from January 2015 to December 2018 were enrolled in the study, as well as 40 patients with chronic hepatitis B (CHB) and 34 healthy controls. ALP levels in peripheral blood of the 3 groups were compared. Differences of the dynamic changes in ALP levels from admission to 1 week after admission were studied. In HBV-ACLF patients, survival rates between increasing ALP group and decreasing ALP group were compared. The associations of the increase of ALP with pre-albumin level and model for end-stage liver disease (MELD) score were analyzed. Results The ALP levels of HBV-ACLF group, CHB group and control group were (421.37 ± 136.35), (116.14 ± 38.62) and (104.23 ± 35.19) U/L, respectively, and the differences among groups were significant (F=77.193, P<0.05). The ALP level of HBV-ACLF group was significantly higher than that of CHB group and control group (Q=3.704 and 4.548, respectively, P<0.05 for both). In HBV-ACLF patients, the increase of ALP of survival subgroup was significantly higher than that of death subgroup, and the difference was statistically significant [(86.17 ± 19.36) vs (29.46 ± 8.21) U/L, t=4.78, P<0.05]. The survival rate of increasing ALP subgroup was higher than that of decreasing ALP subgroup, and the difference was statistically significant (73.08% vs 32.5%, χ² = 33.48, P<0.05). One week after admission, the MELD score of patients with HBV-ACLF was (35.63 ± 5.81), and the pre-albumin level was (73.57 ± 32.69) g/L. The increase of ALP was negatively correlated with MELD score, and positively correlated with pre-albumin level (r=-0.725 and 0.763, respectively, P<0.05 for both).Conclusion The continuous increase of peripheral blood ALP in patients with HBV-ACLF is a predictor of good prognosis.

Key words: Liver failure, Hepatitis B virus, Alkaline phosphatase, Pre-albumin, Model for end-stage liver disease

顾静, 陈祖涛, 孙蔚, 甘建和. 乙型肝炎相关慢加急性肝衰竭患者血清碱性磷酸酶的变化及意义[J]. 肝脏, 2019, 24(11): 1234-1236.

GU Jing, CHEN Zu-tao, SUN Wei, GAN Jian-he. Changes of serum alkaline phosphatase in patients with HBV-related acute-on-chronic liver failure and its significance[J]. Chinese Hepatolgy, 2019, 24(11): 1234-1236.

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