血清胆碱酯酶和总胆汁酸检测在肝脏疾病的应用

黄伟文 柯柳华 王芳

【摘要】目的探讨血清胆碱酯酶（CHE）和总胆汁酸（TBA）检测在肝脏疾病诊断中的临床价值。

方法选择肝脏疾病患者178例，根据不同疾病类型，分为急性病毒性肝炎48例（A组），重症肝炎32例（B组），肝硬化67例（C组），原发性肝癌31例（D组）；另选取同期健康体检者50例作对照组。比较各组的血清CHE、TBA水平及阳性率。

结果四组患者血清CHE及TBA水平均明显高于健康对照组（P<005或0.01），B组CHE明显低于A组（P<005），C组CHE明显低于B组（P<005），C组、D组两组CHE无明显差异（P>0.05）；B组TBA明显高于A组（P<001），C组明显高于B组（P<001），D组明显高于C组（P<001）。四组CHE、TBA阳性率比较，B组明显高于A组（P<005），C组、D组两组无明显差异，但均明显高于B组（P<005）；A组CHE阳性率明显低于TBA的阳性率，C组CHE阳性率明显高于TBA阳性率（P<005）。

结论 在检测ALT的同时，观察CHE、TBA的变化可较全面了解肝组织损害及功能变化情况，对判断其严重程度，指导临床治疗，改善患者预后有着重要的意义。

【关键词】胆碱酯酶；总胆汁酸；肝炎；肝硬化；肝癌

中图分类号：R575文献标识码：ADOI：10.3969/j.issn.10031383.2014.05.017

【Abstract】ObjectiveTo investigate the clinical value of detecting serum cholinesterase （CHE） and total bile acid （TBA） in the diagnosis of liver diseases.

Methods178 patients with liver disease were selected，and they were divided into the group with acute viral hepatitis（group A，48 cases），the group with severe hepatitis（group B，32 cases）， the group with liver cirrhosis（group C，67 cases），and the group with primary liver cancer（group D，31 cases） according to different types of diseases. Meanwhile， 50 healthy people were selected as the control group.Then，serum CHE，TBA levels and positive rates of all groups were compared.

Results Serum CHE and TBA levels of patients in four groups were all significantly higher than those in the control group（P<005 or 0.01），and the CHE of group B was significantly lower than that of group A（P<005）.The CHE of group C was significantly lower than that of group B（P<005），but that of group C was not significantly different from that of group D（P>005）.The TBA of group B was obviously higher than that of group A（P<005），but that of group C was significantly higher than that of group B（P<005），and that of group D was significantly higher than that of group C（P<005）.Comparison of the positive rates of CHE and TBA among four groups showed that those of group B were higher than those of group A（P<005），but those of group C had no significant difference from those of group D，and they were both significantly higher than those of group B（P<005）.The positive rate of CHE of group A was lower than that of TBA，and the positive rate of CHE of group C was significantly higher than that of TBA（P<005）.

ConclusionObserving changes of CHE and TBA whlie detecting ALT can understand the damage of liver tissue and change of function more comprehensively，which has significance in judging severity， guiding clinical treatment and improving patients prognosis.

【Key words】cholinesterase；total bile acid；hepatitis；liver cirrhosis；hepatocellular carcinoma

血清胆碱酯酶（CHE）、总胆汁酸（TBA）的常规检测，逐渐被应用于肝脏疾病的诊断及治疗评估。两者均与肝脏的合成、代谢密切相关，不易受患者饮食及治疗的影响[1]，因此可较全面地反映肝功能状况，其含量的改变对评估肝病病情进展及预后有较大的临床价值。本研究通过检测不同肝脏疾病患者血清CHE、TBA的变化，以探讨二者在肝病中的临床价值。

1资料与方法

1.1临床资料选择2010年1月～2013年12月本市两家三甲医院门诊及住院治疗的肝脏疾病患者178例，其中男126例，女52例；年龄25～72岁（32.1±5.4）岁；急性病毒性肝炎48例（A组），重症肝炎32例（B组），肝硬化67例（C组），原发性肝癌31例（D组）。A组男34例，女12例，年龄（31.7±6.4）岁，体重（64.2±13.0）kg；B组男24例，女8例，年龄（33.5±5.3）岁，体重（62.8±11.7）kg；C组男46例，女21例，年龄（32.0±5.1）岁，体重（63.6±10.8）kg；D组男22例，女9例，年龄（33.0±5.9）岁，体重（64.7±129）kg。各类肝脏疾病的诊断均参照全国病毒性肝炎及肝病学术会议制定的诊断标准[2]。……