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目的研究肝炎肝硬化对肾功能影响因素、变化特点及其临床意义。方法依据《现代传染病学》肝炎肝硬化诊断标准,选择180例肝炎肝硬化患者,其中男性156例,女性24例;年龄26~59岁,平均年龄46.5岁。乙型肝炎肝硬化135例,丙型肝炎肝硬化11例,丁型肝炎肝硬化1例,终末期(死亡组)33例。其中代偿期98例(代偿期肝硬化组),失代偿期49例(失代偿期肝硬化组)。健康对照组40例,其中男性20例,女性20例;年龄32~50岁,平均年龄41.5岁。进行肝功能、血液生物化学检测,分析不同病期、血液系统、肝功能改变及并发症对β2-微球蛋白(β2-MG)、血清尿素(Urea)、肌酐(Cr)、乳酸脱氢酶(LDH)变化、发生率及病死率的相关性。结果 180例患者不同病期血液检测均显示,随病情进展,β2-MG、LDH逐渐升高,差异有显著统计学意义(t=5.37,P<0.01);肝硬化失代偿期Urea与健康对照组比较,差异有显著统计学意义(P<0.01)。120例血液检查,肝炎肝硬化贫血组、中性粒细胞减少组和血小板减少组β2-MG、LDH、Cr及Urea水平与其各自的正常组比较,差异有显著统计学意义(P<0.01);三系血细胞减少组升高最为明显,差异有显著统计学意义(t=3.49,P<0.01)。肝炎肝硬化患者按ALT、AST、AST/ALT比值、甲脂蛋白(AFP)变化分组,其升高组与其正常组及健康对照组比较,各组血清β2-MG、LDH、Cr及Urea均有统计学意义(t=4.25,P<0.05)。随着肝炎肝硬化病情的进展,血细胞减少及肝功能恶化,血清β2-MG、LDH、Cr、Urea水平逐渐升高。结论在肝炎肝硬化病期中检测β2-MG、Urea、Cr、LDH变化可早期发现肾功能损害,并与病情轻重和疾病转归密切相关,是预测肝肾病情和预后的客观指标。
Objective To study the influencing factors, changing characteristics and clinical significance of hepatitis cirrhosis on renal function. Methods According to the diagnostic criteria of hepatitis cirrhosis in modern infectious diseases, 180 patients with cirrhosis of liver were selected, including 156 males and 24 females. The average age was 46.5 years. 135 cases of hepatitis B cirrhosis, 11 cases of hepatitis C cirrhosis, 1 case of hepatitis B cirrhosis, and 33 cases of terminal stage (death group). Among them, 98 were decompensated (decompensated cirrhosis) and 49 were decompensated (decompensated cirrhosis). 40 healthy control group, of which 20 males and 20 females; aged 32 to 50 years old, with an average age of 41.5 years. The liver function and blood biochemical tests were performed to detect the changes of β2-MG, Urea, Cr, Lactate dehydrogenase (LDH) changes, incidence and mortality. Results Blood samples of 180 patients at different stages showed that β2-MG and LDH increased gradually with the progress of the disease, the difference was statistically significant (t = 5.37, P <0.01); Urea of decompensated liver cirrhosis and healthy The difference between the two groups was statistically significant (P <0.01). The blood levels of β2 - MG, LDH, Cr and Urea in 120 patients with hepatic cirrhosis and anemia, neutropenia and thrombocytopenia were significantly different from those in normal controls (P <0.01). Three-line cytopenia group increased most significantly, the difference was statistically significant (t = 3.49, P <0.01). Serum levels of β2-MG, LDH, Cr and Urea in each group were significantly higher than those in normal group and healthy control group according to ALT, AST, AST / ALT ratio and AFP change Statistical significance (t = 4.25, P <0.05). With the progress of hepatitis cirrhosis, cytopenia and deterioration of liver function, serum β2-MG, LDH, Cr, Urea levels gradually increased. Conclusion The detection of β2-MG, Urea, Cr and LDH during the period of hepatic cirrhosis can detect renal dysfunction early, which is closely related to the severity and disease prognosis. It is an objective index to predict the prognosis of liver-kidney disease.