关键词: 乙型肝炎, 肝硬化, 腹水, 血清-腹水白蛋白梯度, 乳酸脱氢酶

Abstract: Objective To investigate the levels of Serum-Ascites Albumin Gradient (SAAG), Serum Lactate Dehydrogenase (LDH), Cancer Antigen 199 (CA199), and Cancer Antigen 125 (CA125) in hepatitis B-related cirrhotic patients with ascites, in order to assess the application value of these biochemical markers in the diagnosis and treatment of this condition. Methods A retrospective analysis was conducted on the clinical data of 94 hepatitis B-related cirrhotic patients with ascites collected from June 2018 to June 2022. According to the Child-Pugh classification of liver cirrhosis, patients were classified into Group A (liver function class A, n=23), Group B (liver function class B, n=46), and Group C (liver function class C, n=25). The levels of SAAG, serum LDH, CA199, and CA125, as well as the prognosis of patients across different liver function classifications were compared. Logistic regression analysis was used to analyze the relationship between the levels of SAAG, serum LDH, CA199, CA125, and liver function classification. The survival curves for patients with different levels of SAAG and serum markers were plotted. The risk factors affecting patient survival were analyzed. Results Patients in Group C had significantly higher levels of SAAG (22.34±2.69 g/L), serum LDH (318.50±22.56 IU/L), CA199 (112.87±66.92), and CA125 (319.41±98.43) compared to those of Group A [SAAG(15.97±2.64 g/L), serum LDH (281.97±21.82 IU/L), CA199 (8.09±5.94), CA125 (19.27±13.91)] and Group B [SAAG(18.86±2.61 g/L), serum LDH(303.42±21.73) IU/L, CA199 (60.52±40.63), CA125(210.56±134.76)], with statistical significance (P<0.05). The deceased group exhibited higher levels of SAAG (21.07±2.84 g/L), serum LDH (309.86±22.57 IU/L), CA199 (86.57±28.85), and CA125 (268.14±58.71) compared to the survival group [SAAG (18.82±2.62 g/L), serum LDH (289.47±21.93 IU/L), CA199 (39.42±13.64), CA125 (103.63±21.43), also with statistical significance (P<0.05)]. The ROC curve analysis shows that the AUCs for SAAG, serum marker levels, and combined diagnosis for liver function grading are 0.863, 0.885, and 0.971, respectively. The sensitivity and specificity of the combined diagnosis are 98.6% and 95.7%, respectively. Logistic regression analysis indicates that high levels of SAAG and serum markers at admission are independent risk factors for patients’ liver function being classified as Grade C (P<0.05); Patients with high levels of SAAG (≥21.68 g/L) at admission have a lower 18-month survival rate than those with low levels of SAAG (<21.68 g/L) (P<0.05). Conclusion Elevated levels of serum SAAG, LDH, CA199, and CA125 in hepatitis B-related cirrhotic patients are associated with the development of ascites. These biochemical markers can serve as auxiliary diagnostic tools for ascites in hepatitis B-related cirrhotic patients, which may facilitate early diagnosis and monitoring disease.

Key words: Hepatitis B, Liver cirrhosis, Ascites, Serum-ascites albumin gradient, Lactate dehydrogenase