原发性胆汁性胆管炎患者血清RDW、Alb、PT与病情严重程度的关系

摘要/Abstract

摘要： 目的观察原发性胆汁性胆管炎患者血清红细胞分布宽度(RDW)、白蛋白(Alb)、凝血酶原时间(PT)与病情严重程度的关系。方法纳入2017年3月至2021年9月淮安市第四人民医院收治的原发性胆汁性胆管炎患者91例及体检健康者60名。91例原发性胆汁性胆管炎患者根据病情严重程度分为非肝硬化组(41例)、肝硬化代偿组(31例)、肝硬化失代偿组(19例)。采用AU5800全自动生化分析仪检测血清Alb,STAGO全自动凝血分析仪检测血清PT,BC-5390血细胞分析仪检测RDW。采用受试者工作特征曲线(ROC)分析血清RDW、Alb、PT水平对原发性胆汁性胆管炎肝硬化的诊断效能。结果观察组RDW、PT分别为(49.6±7.5)%、(14.4±3.4)s,明显大于对照组的(39.8±2.9)%、(12.4±0.7)s,观察组Alb水平为(37.1±7.0)g/L,明显低于对照组的(46.5±2.5)g/L,差异有统计学意义(P<0.05)。非肝硬化组血清RDW、Alb、PT分别为(46.5±4.1)%、(40.3±4.9)g/L、(12.7±0.9)s,肝硬化代偿组血清RDW、Alb、PT分别为(48.8±7.5)%、(38.6±4.8)g/L、(13.4±1.3)s,肝硬化失代偿组血清RDW、Alb、PT分别为(57.4±7.9)%、(28.0±6.5)g/L、(19.8±3.8)s,差异均有统计学意义(P<0.05)。血清RDW、Alb、PT联合诊断原发性胆汁性胆管炎肝硬化的AUC为0.973,明显高于RDW、Alb、PT单独诊断的0.927、0.894、0.707,其敏感度、特异度、准确率可达到92.7%、93.3%、93.0%。结论原发性胆汁性胆管炎肝硬化患者血清RDW、PT水平明显升高,Alb水平明显降低,并且随着疾病的发展进一步加重,RDW、Alb、PT三项指标联合诊断原发性胆汁性胆管炎肝硬化具有较好的效能,可为临床评估该病严重程度提供一定帮助。

关键词: 原发性胆汁性胆管炎, 红细胞分布宽度, 白蛋白, 凝血酶原时间, 诊断

Abstract: Objective To examine serum levels of red blood cell distribution width (RDW), albumin (Alb) and prothrombin time (PT) in primary biliary cholangitis(PBC) patients , and to analyze their association with disease severity. Methods Between March 2017 and September 2021, our hospital recorded 91 PBC patients and 60 healthy subjects. The PBC patients were categorized into non-cirrhotic(47 cases), compensated cirrhotic(29 cases), and decompensated cirrhotic(15 cases) groups, reflecting disease severity. Serum Alb levels were measured using an AU5800 automatic biochemical analyzer, PT was assessed with a STAGO automatic coagulation analyzer; and RDW was determined using a BC-5390 blood cell analyzer. The diagnostic efficacy of serum RDW, Alb, and PT levels for primary biliary cholangitis and cirrhosis was evaluated using the receiver operating characteristic curve (ROC). Results In the observational cohort, serum RDW and PT levels were significantly elevated at 49.6±7.5% and 14.4±3.4 seconds, respectively, compared to 39.8±2.9%and 12.4±0.7 seconds in the control group. Conversely, Alb levels were markedly recuced in the observation group (37.1±7.0 g/L) relative to the control group (46.5 ± 2.5 g/L) (P<0.05). In the non-cirrhosis cohort, serum RDW, Alb, and PT levels were recorded at 46.5±4.1%、40.3±4.9 g/L、and 12.7±0.9 seconds, respectively. The compensated cirrhosis group presented serum RDW, Alb, and PT levels of 48.8±7.5%、38.6±4.8 g/L、and 13.4±1.3 seconds, respectively. In the decompensated cirrhosis group, these levels were significantly higher for RDW(57.4±7.9%) and PT(19.8±3.8 seconds) , and lower for Alb(28.0±6.5 g/L), when compared to both the compensated cirrhosis nd non-cirrhosis groups(P<0.05).The Area Under the Curve(AUC) for the combined diagnostic utility of serum RDW, Alb, and PT levels in distinguishing primary biliary cholangitis and cirrhosis was 0.973, significantly surpassing the AUCs for RDW(0.927), Alb(0.894), and PT(0.707) when used individually. This combined diagnostic approcah achieved a sensitivity, specificity, and accuracy of 92.7%, 93.3%, and 93.0%, respectively, denonstrating superior efficacy. Conclusion In patients with PBC and cirrhosis, serum levels of RDW and PT exhibits significant increase, whereas Alb levels significantly decline. As the disease advances, the combined assessment of RDW, Alb, and PT demonstrates substantial diagnostic efficacy for identifying PBC and cirrhosis, offering valuable insights for the clinical appraisal of disease severity.

Key words: Primary biliary cholangitis, red blood cell distribution width, Albumin, Prothrombin time, diagnosis

堵妍, 吴婷婷, 张媛媛, 陈星. 原发性胆汁性胆管炎患者血清RDW、Alb、PT与病情严重程度的关系[J]. 肝脏, 2024, 29(3): 323-326.

DU Yan, WU Ting-ting, ZHANG Yuan-yuan, CHEN Xing. Correlation of serum red blood distribution width, albumin, prothrombin time with disease severity in primary biliary cholangitis patients[J]. Chinese Hepatolgy, 2024, 29(3): 323-326.

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