CAJ | 학술논문

目的探讨血清前白蛋白浓度测定在临床肝功能损害评价中的价值.方法分析80例接受脾切除+贲门周围血管离断术的肝硬化患者术前血清前白蛋白(PA)水平、终末期肝病模型(MELD)与术后出现肝功能衰竭的关系.结果术后出现肝功能衰竭的患者术前的PA值为(79.8±28.5)mg/L,较术后未出现肝功能衰竭情况患者的术前PA值(149.6±31.5)mg/L明显降低(P＜0.01).单独使用MELD评分≥9分和PA值＜100mg/L来判断肝硬化门脉高压患者术后是否出现肝功能衰竭的敏感性分别为71.4%和69.6%,使用MELD评分联合PA值来判断术后是否出现肝功能衰竭的敏感性为82.4%,明显高于单独使用MELD和PA值(P＜0.01).单独使用MELD评分≥9分、PA值＜100 mg/L和MELD评分联合PA值三种方法对术后肝功能衰竭情况评价的特异性都较强,分别为93%、91.5%和90.5%,但三种方法之间的差异无统计学意义(P＞0.05).结论前白蛋白可反映乙肝后肝硬化门脉高压患者的肝功能损害程度.术前MELD评分联合PA值评估术后是否出现肝功能衰竭情况有良好的敏感性及特异性,可应用于临床.
목적 탐토혈청전백단백농도측정재림상간공능손해평개중적개치.방법 분석80례접수비절제+분문주위혈관리단술적간경화환자술전혈청전백단백(PA)수평、종말기간병모형(MELD)여술후출현간공능쇠갈적관계.결과 술후출현간공능쇠갈적환자술전적PA치위(79.8±28.5)mg/L,교술후미출현간공능쇠갈정황환자적술전PA치(149.6±31.5)mg/L명현강저(P＜0.01).단독사용MELD평분≥9분화PA치＜100mg/L래판단간경화문맥고압환자술후시부출현간공능쇠갈적민감성분별위71.4%화69.6%,사용MELD평분연합PA치래판단술후시부출현간공능쇠갈적민감성위82.4%,명현고우단독사용MELD화PA치(P＜0.01).단독사용MELD평분≥9분、PA치＜100 mg/L화MELD평분연합PA치삼충방법대술후간공능쇠갈정황평개적특이성도교강,분별위93%、91.5%화90.5%,단삼충방법지간적차이무통계학의의(P＞0.05).결론 전백단백가반영을간후간경화문맥고압환자적간공능손해정도.술전MELD평분연합PA치평고술후시부출현간공능쇠갈정황유량호적민감성급특이성,가응용우림상.
Objective To investigate the clinical use of serum prealbumin (PA) in evaluating liver function damage. Methods Preoperative PA and the model for end-stage liver disease (MELD) score were retrospectively analyzed in 80 patients with liver cirrhosis and portal hypertension undergoing splenectomy and devascularization around the cardia. The correlation of preoperative PA level and MELD score with postoperative hepatic failure was also analyzed. Results The mean serum value of PA in the patients with hepatic failure was (79. 8 ± 28.5 ) mg/L, and that in thouse without hepatic failure was ( 149. 6 ±31.5 ) mg/L ( P ＜ 0. 01 ). The sensitivity of using MELD score ≥9 to evaluate postoperative hepatic failure was 71.4%, that of PA ＜ 100 mg/L was 69. 6%, and that of MELD score ≥9 combined with PA ＜ 100mg/L was 82. 4% respectively (P ＜0. 01 ). The specificity of the three methods was 93%, 91.5% and 90. 5% respectively, with the difference being not significant (P ＞ 0. 05). Conclusion The serum level of PA could reflect the liver function damage sensitively and exactly. Preoperative MELD score combined with serum PA has good sensitivity and specificity in predicting postoperative hepatic failure and could be used clinically.