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[目的]分析不同同型半胱氨酸(Hcy)水平对乙肝肝硬化患者预后的影响。[方法]纳入2014年1月~2015年1月我院收诊的119例乙肝肝硬化患者作为研究资料进行分析,以1年内发生的不良事件为判断预后的标准。将119例患者血清Hcy水平与肝功能Child-Pugh得分进行Pearson相关分析,得出两者的关系,再根据不同肝功能Child-Pugh等级将患者分为Hcy水平不同的3组,分析不同Hcy水平患者肝功能指标谷丙转氨酶(ALT)、总胆红素(TBiL)和肝纤维化指标Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)的关系,分析Hcy对肝功能和肝纤维化的影响,观察1年期内3组不同Hcy水平患者发生不良事件的比例,探讨Hcy水平对患者不良事件的影响。[结果]患者血清Hcy水平和肝功能Child-Pugh得分呈正相关(P<0.05)。Child-Pugh C级患者血清ALT、TBiL、PCⅢ和Ⅳ-C水平分别为(90.73±1.63U/L、59.42±1.49μmol/L、201.48±14.83ng/ml和284.52±15.88ng/ml),均高于Child-Pugh B级患者(65.02±1.52U/L、38.71±1.22μmol/L、170.39±13.40ng/ml和261.48±15.73ng/ml)(均P<0.05),Child-Pugh B级患者以上指标水平均高于Child-Pugh A级患者(46.23±1.40 U/L、27.51±1.60μmol/L、149.25±12.04ng/ml和238.51±13.39ng/ml)(均P<0.05),Hcy水平越高,肝功能越差和肝纤维化越严重。一年内Hcy高水平组患者发展为肝癌比例、肝性脑病比例、肝肾综合征比例、上消化道出血发生比例、发生腹水比例分别为(12.50%、17.50%、20.00%、17.50%、25.00%),均高于Hcy中等水平组(2.22%、4.44%、6.67%、4.44%、6.67%)(均P<0.05)和Hcy低水平组(0、0、3.03%、0、3.03%),Hcy高水平组有2例患者死亡,其他2组无死亡病例,在以上不良事件发生比例上,Hcy低水平组和Hcy中等水平组差异无统计学意义。[结论]肝功能Child-Pugh评分越高,患者血清Hcy水平越高,随着血清Hcy水平的升高,患者肝功能越差、肝纤维化越严重,进而影响患者预后情况。
[Objective] To analyze the effect of different homocysteine (Hcy) levels on the prognosis of patients with hepatitis B cirrhosis. [Methods] A total of 119 hepatitis B cirrhosis patients admitted to our hospital from January 2014 to January 2015 were analyzed as research data, and adverse events within 1 year were used as criteria for prognosis. 119 cases of patients with serum Hcy levels and liver function Child-Pugh score Pearson correlation analysis, the relationship between the two, and then according to different liver function Child-Pugh level will be divided into three groups with different Hcy levels, analysis of different Hcy levels (ALT), total bilirubin (TBiL) and hepatic fibrosis indicators type Ⅲ procollagen (Ⅲ) and type Ⅳ collagen (Ⅳ-C) in patients with liver dysfunction were analyzed. The effect of Hcy on liver function and liver fibrosis To observe the proportion of adverse events in three groups of patients with different Hcy levels within one year and explore the effect of Hcy on adverse events in patients. [Results] The serum Hcy level was positively correlated with Child-Pugh score of liver function (P <0.05). The levels of serum ALT, TBiL, PCⅢ and Ⅳ-C in Child-Pugh C group were (90.73 ± 1.63U / L, 59.42 ± 1.49μmol / L, 201.48 ± 14.83ng / ml and 284.52 ± 15.88ng / ml respectively) (65.02 ± 1.52U / L, 38.71 ± 1.22μmol / L, 170.39 ± 13.40ng / ml and 261.48 ± 15.73ng / ml respectively) (all P <0.05), Child-Pugh class B patients (46.23 ± 1.40 U / L, 27.51 ± 1.60μmol / L, 149.25 ± 12.04ng / ml and 238.51 ± 13.39ng / ml respectively) (all P <0.05). The levels of Hcy The higher the worse liver function and liver fibrosis more serious. Within one year, the patients with high Hcy level developed hepatocellular carcinoma, hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal bleeding, and ascites rates (12.50%, 17.50%, 20.00%, 17.50%, 25.00% ) Were higher than those in Hcy group (2.22%, 4.44%, 6.67%, 4.44%, 6.67%, P <0.05) Hcy high level group, 2 patients died, the other two groups no deaths, in the proportion of the above adverse events, Hcy low level group and Hcy moderate level group no significant difference. [Conclusion] The higher the Child-Pugh score of liver function, the higher the serum Hcy level. With the increase of serum Hcy level, the worse the liver function and the more severe liver fibrosis, which will affect the prognosis of patients.