PDF下载 ( 1392 KB)
The dynamic changes of AST, ALT, TBil and PT and their relationship with prognosis of acute-on-chronic hepatitis B liver failure
-
摘要: 目的分析ALT、AST、TBil、PT在慢加急性乙型肝炎肝衰竭患者病程中的动态变化趋势及其对预后判定的意义。方法499例慢加急性乙型肝炎肝衰竭的患者,按临床结局分为存活组和死亡组。入院后每周检测其血清ALT、AST、TBil、PT,分析上述指标动态变化趋势及与慢加急性乙型肝炎肝衰竭预后的关系。结果入院时两组间ALT水平差异无统计学意义,但入院第2～6周,死亡组ALT水平高于存活组(P<0.05),而死亡组AST水平则在入院第1～5周均高于存活组(P<0.05)。两组ALT及AST均随时间呈下降趋势,但在相同时间里死亡组ALT及AST下降幅度较存活组小,入院第6周后两组ALT、AST水平差异无统计学意义。死亡组患者TBil、PT水平在入院后各周检测均高于存活组(P<0.001)。在第一周内两组TBil均升高,但从入院后第二周开始,存活组TBil、PT达峰值后开始随时间逐渐下降,而死亡组TBil、PT则随时间持续升高。结论慢加急性乙型肝炎肝衰竭患者入院后早期ALT、AST、TBil、PT的变化趋势可以反映其预后,动态观察其变化有助于早期判断慢加急性乙型肝炎肝衰竭患者的预后...Abstract: Objective To analyze the dynamic changes of serum alanine transaminase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBil) , prothrombin time (PT) levels and their prognostic significance in acute-on-chronic hepatitis B liver failure.Methods 499 cases of hepatitis B patients with acute-on-chronic liver failure were divided into the survival group and death group according to the clinical outcomes.After admission, serum ALT, AST, TBil, and PT were detected every week.The dynamic changes of these indicators and relationship with prognosis of these patients were analyzed.Results 1.Serum ALT levels on admission were comparable between survival group and death group.However, serum ALT levels in patients of death group were significantly higher than those in survival group from 2nd-6th week (P<0.05) , and serum AST levels in patients of death group were significantly higher than those of survival group from admission to 5th week (P<0.05) .ALT and AST levels showed a downward trend over time.Six weeks later ALT, AST levels between the two groups were basically normal and comparable.2.The TBil and PT levels in patients of death group were significantly higher than those of survival group at every week (P<0.001) .Within the first week, TBil and PT levels increased in both groups.However, from the second week, the TBil and PT levels gradually decreased from the peak in survival group, but elevated in death group over time.Conclusion In patients with acute-on-chronic liver failure, the dynamic changes of serum ALT, AST, TBil and PT levels in early stage after admission could predict the clinical outcomes, which could be useful in prognostic evaluation.
-
Key words:
- liver failure /
- prognosis
-
[1]Lee WM, Squires RH Jr, Nyberg SL, et al.Acute liver fail-ure:Summary of a workshop[J].Hepatology, 2008, 47 (4) :1401-1415. [2]Lai Q, Molinaro A, Mennini G, et al.Preoperative donorscores and postoperative early measures of graft function:relevance to the outcome of liver transplantation[J].ClinGastroenterol Hepatol, 2009, 7 (11) :1236-1240. [3]Sumskiene J, Kupcinskas L, Pundzius J, et al.Prognosticfactors for short and long-term survival in patients selectedfor liver transplantation[J].Medicina (Kaunas) , 2005, 41 (1) :39-46. [4] 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊疗指南[J].中华内科杂志, 2006, 14 (9) :643-646. [5]Bak-Nafalska K, Piotrowska A, Wójcicki M, et al.Prognos-tic indices in liver cirrhosis and transplant assessment[J].Transplant Proc, 2010, 42 (4) :1209-1211. [6]邹正升, 陈菊梅, 辛绍杰, 等.影响慢性重型肝炎预后的单因素研究——附520例临床分析[J].中华实验和临床病毒学杂志, 2002, 16 (3) :246-248. [7]李海军, 李东, 许景耀, 等.乙型病毒性肝炎导致的慢性肝功能衰竭患者死亡危险因素分析[J].临床军医杂志, 2009, 37 (2) 243-245. [8]彭新国, 姚津剑, 于伟玲, 等.重型乙型肝炎预后荟萃分析[J].中华实验和临床感染病杂志 (电子版) , 2011, 5 (1) :14-19. [9]罗玲, 袁春兰, 赖宁, 等.重型肝炎预后因素分析与护理对策[J].世界华人消化杂志, 2011, 19 (19) :2068-2071. [10]武文芳, 张晶, 段钟平, 等.重型肝病患者预后生存模型的研究[J].中国医疗设备, 2008, 23 (8) :6-9. [11]Huang K, Hu JH, Wang HF, et al.Survival and prognostic fac-tors in hepatitis B virus-related acute-on-chronic liver failure[J].World J Gastroenterol, 2011, 17 (29) :3448-3452. [12]高艳颖, 韩涛, 阚志超.慢性肝衰竭患者预后的影响因素[J].世界华人消化杂志, 2008, 16 (29) :3343-3346. [13]Dhiman RK, Seth AK, Jain S, et al.Prognostic evaluation ofearly indicators in fulminant hepatic failure by multivariate a-nalysis[J].Dig Dis Sci, 1998, 43 (6) :1311-1316. -
本文二维码
计量
- 文章访问数: 3867
- HTML全文浏览量: 23
- PDF下载量: 959
- 被引次数: 0
下载:
