摘要
目的研究脱-γ-羧基凝血酶原（DCP）在肝硬化患者肝功能评价及预后评估中的作用。方法纳入2013年1月至2016年8月在上海长征医院就诊的137例肝硬化患者，检测血清DCP水平，收集临床资料，随访并发症发生情况及生存情况。将137例患者分为DCP阴性组（DCP≤40 mAU/mL）118例和DCP阳性组（DCP〉40 mAU/mL）19例，将45例代偿期肝硬化患者分为DCP高水平组（DCP〉16.5 mAU/mL）32例和DCP低水平组（DCP≤16.5 mAU/mL）13例。利用卡方检验分析不同Child-Pugh分级患者DCP阳性率差异，利用Spearman相关性检验分析DCP与终末期肝病模型（MELD）的相关性，利用Kaplan-Meier检验分析DCP与肝病相关病死率的相关性。结果与DCP阴性组相比，DCP阳性组患者白蛋白水平降低[35 g/L（20～57 g/L）比29 g/L（17～42 g/L）]，TBil水平、PT和国际标准化比值均升高[分别为12.9 mg/L （1.8～83.0 mg/L）比22.2 mg/L（6.4～169.0 mg/L），15.5 s（11.7～35.7 s）比17.5 s（13.9～33.4 s），1.24（0.96～3.72）比1.44（1.09～3.22）]，差异均有统计学意义（Z＝－2.785、－2.891、－2.945、－2.879，P均〈0.01）。Child-Pugh A、B、C级患者DCP阳性率（DCP〉40 mAU/mL）分别为1.8%（1/55）、21.2%（11/52）、23.3%（7/30），差异有统计学意义（χ2＝11.246，P＝0.003）。Child-Pugh分级较高（B、C级）的肝硬化患者DCP水平与MELD评分呈显著正相关（r＝0.259，P＝0.021）。DCP阳性组分别有16、3例患者发生腹水和自发性细菌性腹膜炎（SBP），其发生率高于DCP阴性组的55.1%（65/118）和1.7%（2/118），差异均有统计学意义（χ2＝5.744、97.636，P均〈0.05）。DCP高水平组临床失代偿的比例为53.1%（17/32），DCP低水平组有2例患者发生失代偿，差异有统计学意义（χ2＝5.397，P＝0.024）。DCP阳性组有9例患者存活，总体生存率低于DCP阴性组的87.9%（87/99），差异有统计学意义（χ2＝5.442，P＝0.020）。结论肝硬化患者血清DCP水平与肝功能、腹水和SBP的发生密切相关，且与代偿期发生失代偿和肝硬化肝病相关死亡相关，可能成为肝硬化临床诊治中判断疾病严重程度和预后的有用的血清学指标。
ObjectiveTo investigate the role of des-gamma-carboxy prothrombin （DCP） in assessment of liver function and prognosis of patients with liver cirrhosis. MethodsFrom January 2013 to August 2016, a total of 137 patients with liver cirrhosis in Shanghai Changzheng Hospital were enrolled. The serum DCP level was measured, the clinical data was collected and the complication and survival situation was followed up. The 137 patients were divided into DCP negative group （DCP≤40 mAU/mL, 118 cases） and DCP positive group （DCP〉40 mAU/mL, 19 cases）. Forty-five patients with compensated liver cirrhosis were divided into high-level DCP group （DCP〉16.5 mAU/mL, 32 cases） and low-level DCP group （DCP≤16.5 mAU/mL, 13 cases）. Chi square test was used to analyze the difference in the positive rate of DCP in patients with different Child-Pugh classification. Spearman correlation test was performed to analyze the correlation between DCP and model for end-stage liver disease （MELD） scores. Kaplan-Meier survival curve was used to analyze the correlation between DCP and liver disease related mortality. ResultsCompared to that of DCP negative group, albumin level of patients in DCP positive group decreased （35 g/L, 20 to 57 g/L vs. 29 g/L, 17 to 42 g/L）, however, total bilirubin （TBil）, prothrombin time （PT）, and international normalized ratio all increased （12.9 mg/L, 1.80 to 83.0 mg/L vs.22.2 mg/L, 6.4 to 169.0 mg/L; 15.5 s, 11.7 to 35.7 s vs.17.5 s, 13.9 to 33.4 s; 1.24, 0.96 to 3.72 vs.1.44, 1.09 to 3.22）, and the differences were statistically significant （Z=-2.785, -2.891, -2.945 and -2.879, all P〈0.01）. The DCP positive （DCP〉40 mAU/mL） rates of Child-Pugh A, B and C patients were 1.8% （1/55）, 21.2% （11/52） and 23.3% （7/30）, respectively, and the difference was statistically significant （χ2=11.246, P=0.003）. The DCP levels of patients with Child-Pugh class B and C cirrhosis were significantly correlated with MELD scores （r=0.259, P=0.021）. There were 16 and three patients with ascites and spontaneous bacterial peritonitis （SBP） of DCP positive group, and the incidence was higher than that of DCP negative group （55.1%, 65/118 and 1.7%, 2/118）, and the differences were statistically significant （χ2=5.744 and 97.636, both P〈0.05）. Patients in high-level DCP group had a higher proportion of clinical decompensation than low-level DCP group （53.1% （17/32） and two cases）, the difference was statistically significant （χ2=5.397, P=0.024）. The overall survival rate of DCP positive group （nine survival cases） were lower than that of DCP negative group （87.9%, 87/99）, and the difference was statistically significant （χ2=5.442, P=0.020）. ConclusionsSerum DCP level is closely related to liver function, ascites and SBP in patients with liver cirrhosis. Furthermore, it is associated with occurrence of decompensation in compensated patients and liver-related mortality in patients with liver cirrhosis. DCP may be a useful serum marker for evaluation of disease severity and prognosis in patients with liver cirrhosis in clinical practice.
作者
赵晨
许文萍
王泽瑞
时培美
高春芳
谢渭芬
Zhao Chen;Xu Wenping;Wang Zerui;Shi Peimei;Gao Chun fang;X ie Wei fen(Department of Gastroenterology,Changzheng Hospital,Shanghai 200003,Chin)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2018年第6期394-399,共6页
Chinese Journal of Digestion
基金
国家自然科学金青年项目(81502077)
上海市教育委员会晨光项目(15CG41)
关键词
肝硬化
脱-Γ-羧基凝血酶原
肝功能
预后
Liver cirrhosis
Des-gamma-carboxy prothrombin
Liver fuction
Prognosis
