病毒性肝炎肝硬化患者3项生化指标与肝储备功能、合并症的关系

摘要/Abstract

摘要： 目的观察病毒性肝炎肝硬化患者血清乳酸脱氢酶(LDH)、5′-核苷酸(5′-NT)、天冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)与肝储备功能及合并腹水的关系。方法选取2020年6月至2023年6月连云港市第一人民医院收治的病毒性肝炎肝硬化患者100例,其中合并腹水40例,无腹水60例。Child-Pugh分级A级39例,B级37例,C级24例。比较不同肝功能分级患者及合并腹水组与无腹水组患者血清LDH、5′-NT、AST、ALT水平及AST/ALT。采用Spearman相关系数分析血清LDH、5′-NT和AST/ALT与病毒性肝炎肝硬化患者肝储备功能的关系,logistic回归分析血清合并腹水的影响因素。结果 C级患者血清LDH(317.79±35.56)IU/L、5′-NT(19.36±2.15)U/L、AST(174.06±18.38)U/L、ALT(140.43±16.62)U/L及AST/ALT(1.24±0.15)均高于B级(298.41±32.27)IU/L、(15.69±2.01)U/L、(138.41±15.05)U/L、(120.84±14.49)U/L、(1.15±0.12)和A级(280.25±30.14)IU/L、(11.14±1.53)U/L、(100.15±13.39)U/L、(92.12±11.23)U/L、(1.09±0.10),且B级高于A级(F=10.211、149.576、178.196、96.344、11.457,P<0.05)。合并腹水组患者血清LDH(313.97±32.25)IU/L、5′-NT(18.89±2.11)U/L、AST(168.32±18.85)U/L、ALT(130.25±15.56)U/L及AST/ALT(1.29±0.15)均高于无腹水组(283.98±29.67)IU/L、(12.07±1.56)U/L、(107.86±12.27)U/L、(103.74±12.29)U/L、(1.04±0.13)(t=4.782、18.571、19.444、42.782、8.855,P<0.05)。Spearman相关性分析显示,血清LDH、5′-NT及AST/ALT与患者肝储备功能均呈正相关性(r=0.415、0.657、0.632,P<0.05)。Logistic回归分析显示,血清LDH、5′-NT及AST/ALT可能是病毒性肝炎肝硬化患者并发腹水的危险因素(OR=3.369、2.748、1.425,P<0.05)。结论血清LDH、5′-NT和AST/ALT比值与病毒性肝炎肝硬化患者肝储备功能及合并腹水的发生密切相关。

关键词: 病毒性肝炎, 肝硬化, 肝储备功能, 腹水, 乳酸脱氢酶, 5′-核苷酸, 天冬氨酸氨基转移酶/丙氨酸氨基转移酶

Abstract: Objective To observe the relationship between serum lactate dehydrogenase (LDH), 5′-nucleotide (5′-NT), and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratios and the function of hepatic reserve and consolidated ascites in viral hepatitis-related cirrhotic patients. Methods One hundred cirrhotic patients with viral hepatitis admitted from June 2020 to June 2023 were selected, including 40 cases complicated with ascites (ascites group) and 60 cases without ascites (non-ascites group). Serum LDH, 5′-NT, AST, and ALT were measured at the time of admission, and the AST/ALT ratio was calculated. Serum LDH, 5′-NT, AST, ALT levels and AST/ALT ratios were compared between patients with different hepatic function classifications (Child-Pugh classification: 39 cases of class A, 37 cases of class B, 24 cases of class C) and in different groups. The relationship between serum LDH, 5′-NT, and the AST/ALT ratio and the hepatic reserve function of patients with viral hepatitis-related cirrhosis was analyzed by Spearman′s correlation coefficient analysis, and the relationship between serum LDH, 5′-NT, and AST/ALT ratio and the combined ascites was analyzed by logistic regression analysis. Results Serum LDH (317.79±35.56) IU/L, 5′-NT (19.36±2.15) U/L, AST (174.06±18.38) U/L, ALT (140.43±16.62) U/L, and AST/ALT ratio (1.24±0.15) were higher in patients with grade C than those of (298.41± (32.27) IU/L, (15.69±2.01) U/L, (138.41±15.05) U/L, (120.84±14.49) U/L, (1.15±0.12) in grade B patients and (280.25±30.14) IU/L, (11.14±1.53) U/L, (100.15±13.39) U/L, (92.12±11.23) U/L, (1.09±0.10) in grade A patients. The values in grade B patients was higher than those of grade A patients (F=10.211, 149.576, 178.196, 96.344, 11.457, P<0.05). Serum LDH (313.97±32.25) IU/L, 5′-NT (18.89±2.11) U/L, AST (168.32±18.85) U/L, ALT (130.25±15.56) U/L, and AST/ALT ratio (1.29±0.15) in the combined ascites group were higher than those of (283.98± (29.67) IU/L, (12.07±1.56) U/L, (107.86±12.27) U/L, (103.74±12.29) U/L, and (1.04±0.13) in the non-ascites group (t=4.782, 18.571, 19.444, 42.782, and 8.855, P<0.05). Spearman′s correlation analysis showed that serum LDH, 5′-NT and AST/ALT ratio were all positively correlated with the patients′ hepatic reserve function (r=0.415, 0.657, 0.632, P<0.05). Logistic regression analysis showed that serum LDH, 5′-NT and AST/ALT ratio might be the patients with cirrhosis of viral hepatitis with risk factors for concurrent ascites (OR=3.369, 2.748, 1.425, P<0.05). Conclusion Serum LDH, 5′-NT and AST/ALT ratio are strongly associated with liver reserve function and the occurrence of ascites in viral hepatitis-related cirrhotic patients.

Key words: Viral hepatitis, Cirrhosis, Liver reserve function, Ascites, Lactate dehydrogenase, 5′-Nucleotide, Aspartate aminotransferase/alanine aminotransferase

苗晗, 赵丹丹, 嵇海艳, 宋晓东. 病毒性肝炎肝硬化患者3项生化指标与肝储备功能、合并症的关系[J]. 肝脏, 2025, 30(7): 922-925.

MIAO Han, ZHAO Dan-dan, JI Hai-yan, SONG Xiao-dong. An investigation on the relationship between three biochemical indices and liver reserve function and comorbidities of viral hepatitis-related cirrhotic patients[J]. Chinese Hepatolgy, 2025, 30(7): 922-925.

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