中国中西医结合儿科学 ›› 2021, Vol. 13 ›› Issue (4): 336-.

• 临床研究 • 上一篇    下一篇

血清白蛋白与肝内胆汁淤积症患儿肝肋下肿大程度、凝血功能的相关性分析

目的:分析血清白蛋白（ALB）与肝内胆汁淤积症（NICCD）患儿肝肋下肿大程度、凝血功能的相关性。
方法:2017年3月至2020年3月对我院收治的NICCD患儿56例临床资料进行回顾性分析，根据血清ALB水平分为低ALB组（ALB＜30 g/L）26例和ALB正常组（ALB≥30 g/L）30例，比较两组患儿肝肋下肿大程度及凝血功能指标［活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原（FIB）］差异，采用Spearman相关性分析法分析NICCD患儿血清ALB水平与肝肋下肿大程度及凝血功能指标水平的相关性。根据NICCD患儿预后肝功能情况分为预后良好组［ALB 35～55 g/L、谷丙转氨酶≤40 U/L］43例和预后不良组（ALB＜35 g/L或＞55 g/L、谷丙转氨酶＞40 U/L）13例，以受试者工作特征（ROC）曲线描述肝肋下肿大程度及凝血功能指标应用于NICCD患儿预后肝功能的预测效能。
结果:低ALB组肝肋下肿大程度及APTT水平均显著高于ALB正常组，FIB水平显著低于ALB正常组，差异有统计学意义（P<0.05）；两组PT和TT水平比较差异均无统计学意义（P>0.05）。Pearson相关分析结果表明，NICCD患儿ALB水平与肝肋下肿大程度及APTT水平呈负相关，与FIB水平呈正相关（P<0.05），与PT及TT水平无相关性（P>0.05）。预后良好组肝肋下肿大程度及APTT水平均明显低于预后不良组，FIB水平明显高于预后不良组，差异有统计学意义（P<0.05）；两组PT和TT水平比较差异均无统计学意义（P>0.05）。肝肋下肿大程度、APTT及FIB预测NICCD患儿预后不良的截断值分别为3.3 cm、46.7 s、1.4 g/L。
结论:血清ALB水平与NICCD患儿肝肋下肿大程度、凝血功能密切相关，且NICCD患儿肝肋下肿大程度及APTT、FIB水平与其预后肝功能密切相关，其检测可用于新生儿肝功能不良预后防治。   

Correlation analysis of serum albumin with liver function and coagulation function in children with NICCD

Objective:To analyze the correlation between serum albumin(ALB) and liver function and coagulation function in childrenwith intrahepatic cholestasis(NICCD).#br# Methods:The clinical data of 56 children with NICCD treated in our hospital between March 2017 and March 2020 were retrospectively analyzed. Based on the level of serum ALB, these children weredivided into low-ALB group(ALB<30 g/L)(26 cases) and normal-ALB group (ALB≥30 g/L)(30 cases). Compare the differences in the degree of subcostal hepatomegaly and the coagulation indexes［(activatedpartial thromboplastin time(APTT), prothrombin time(PT), thrombin time(TT) and fibrinogen(FIB)］. Spearman correlation analysis method was used to analyze the correlation of the level of serum ALB with the degree of subcostal hepatomegaly and coagulation indexes in children with NICCD. Based on the prognosticliver function of NICCD children, they were divided into good-prognosis group (ALB=35-55 g/L, alanine transaminase≤40 U/L)(43 cases) and bad-prognosis group(ALB<35 g/L or ALB>55 g/L, alaninetransaminase>40 U/L)(13 cases). ROC was used to describe the efficiency of the degree of subcostal hepatomegaly and coagulation indexes in predicting the prognostic liver function of NICCD children.#br# Results:The degree of subcostal hepatomegalyand the APTT level were significantly higher in low-ALB group than in normal-ALB group,while FIB level was significantly lower, and there was statistical difference (P<0.05); there was no statistical difference in the PT level or TT level between the two groups(P>0.05). Pearson correlation analysis showedthat the ALB level was negatively correlated with the degree of subcostal hepatomegaly and APTT level, andpositively correlated with FIB level (P<0.05), but not correlated with PT or TT level(P>0.05). The degree of subcostal hepatomegaly and APTT level were significantly lower in good-prognosis group than in bad-prognosis group, while FIB level was significantly higher(P<0.05), but there was no statistical difference in PT or TT level between the two groups(P>0.05). The cut-off value of the degree of subcostal hepatomegaly, APTT and FIB in predicting bad prognosis of NICCD children was 3.3 cm, 46.7 s and 1.4 g/L, respectively.#br# Conclusion:The level of serum ALB is related to the degree of subcostal hepatomegaly and coagulation function inNICCD children, and the degree of subcostal hepatomegaly and the level of APTT and FIB of NICCD children are closely correlated with their prognostic liver function, so the detection of them can be used in the prevention and treatment of bad prognosis of liver function in neonates.   

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