【摘要】 目的评价血S100B蛋白和尿乳酸/肌酐对乙肝肝硬化门脉高压症术后肝性脑病发生的早期预测价值。方法回顾性分析65例乙肝肝硬化门脉高压症患者的临床资料,动态检测术后24、48和72h的血S100B蛋白和尿乳酸/肌酐比值水平,根据是否发生术后肝性脑病将受试者分为肝性脑病组与非肝性脑病组,并对肝性脑病组患者进行临床分度。结果乙肝肝硬化门脉高压症患者术后发生肝性脑病组72h内血S100B蛋白含量和24 h内尿乳酸/肌酐比值水平明显高于非肝性脑病组(P<0.001);72h内血S100B蛋白含量和24 h内尿乳酸/肌酐比值之间及与肝性脑病的临床分度呈正相关(P<0.001);当血S100B水平在28ng/L,尿乳酸/肌酐比值在0.47时,单独检测72h血S100B蛋白的敏感度、特异度分别为91.2%、93.6%;尿乳酸/肌酐比值预测肝性脑病的敏感度和特异性度以术后24h最高,分别为89.3%和91.7%;如检测72h血S100B蛋白的同时监测术后24h尿乳酸/肌酐比值可显著提高肝性脑病诊断的准确性,联合应用两项指标进行检测,诊断的敏感度和特异度分别为95.7%和98.6%,较两种方法单独应用敏感度和特异度均提高。结论对门静脉高压症患者术后以临床表现为基础,同时监测72h内血S100B蛋白和24h尿乳酸/肌酐比值,对提高术后肝性脑病的早期诊断和临床分度具有一定应用价值。更多还原

【Abstract】 Objective To evaluate the predictive value of Blood S100B protein and urinary lactate/creatinine ratio for hepatic encephalopathy after hepatisis B cirrhosis-related portal hypertension operation.Method The clinical data of 65 cases subject to hepatisis B cirrhosis-related portal hypertension were retrospectively analyzed.The levels of blood S100B protein and urinary lactate/creatinine ratio were dynamically monitored at 24,48 and 72 h after operaion.The patients were divided into two groups: hepatic encephalopathy(experimental) group amd non hepatic encephalopathy(control) group.The severity of clinical manifestations,including the degree of hepatic encephalopathy,were also analyzed.Result (1) The Blood S100B protein level of hepatic encephalopathy patients was significantly higher in samples collected throughout the monitoring period than those of normal control groups(all P<0.001).The urinary lactate/creatinine ratio of hepatic encephalopathy group was also significantly higher than that of normal control groups within the 24 h(P<0.001).(2) A significantly positive correlation was found between the level of blood S100B protein within 72 h and the urinary lactate/creatinine ratio within 24 h and between the level of blood S100B protein within 72h and clinical degree(P<0.05).(3) When S100B was 28 ng/L and urinary lactate/creatinine ratio was 0.47,the sensitivity and sepcificity of detecting the 72 h Blood S100B alone,were respectively 91.2% and 93.6%.Those of detecting the 24 h urinary lactate/creatinine ratio alone,were 89.3% and 91.7% respectively.The detection,when asscociated with the 24 h urinary lactate/creatinine ratio,had increased the sensitivity and spectivity(respectively 95.7%,98.6%) for predicting development of hepatic encephalopathy.Conclusion On the basis of clinical manifestations of patients after portal hypertension operation,detecting the level of the 72 h Blood S100B and 24 h urinary lactate/creatinine ratio may be of important value in early diagnosis and grading of hepatic encephalopathy.更多还原