Page 51 - 2022-12-中国全科医学

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intervention in patients with end-stage liver disease. Methods From September 2020 to May 2021，21 patients with ACLF
hospitalized in the Fourth Department of Liver Disease，Beijing You'an Hospital，Capital Medical University were enrolled as the
ACLF group by continuous fixed-point sampling. Nine patients with compensated liver cirrhosis who were hospitalized at the same
time for elective endoscopic treatment or reexamination were enrolled as the liver cirrhosis group，and the patients were all in the
compensatory period. Five healthy controls were enrolled as healthy control group. ACLF patients and liver cirrhosis patients were
divided into alcoholic liver disease subgroup and non-alcoholic liver disease subgroup according to the cause of disease. The mass
spectrometry was used to detect the levels of vitamin B 1 ，vitamin B 6 ，25-hydroxyvitamin D，25-hydroxyvitamin D 3 and trace
elements（zinc，manganese，selenium ）in peripheral blood，in order to analyze the relationship between the levels of vitamins
and trace elements in patients with liver cirrhosis and liver failure and the cause and severity of the disease〔total bilirubin（TBiL），
serum albumin（ALB），international normalized ratio（INR），Child-Pugh and MELD scores〕. Results The levels of
TBiL，INR，scores of Child-Pugh and MELD in ACLF group were significantly higher than those in liver cirrhosis group，ALB
was significantly lower than that in liver cirrhosis group（P<0.05）. The levels of 25-hydroxyvitamin D，25-hydroxyvitamin D 3
and blood selenium in ACLF group were significantly lower than those in healthy control group and liver cirrhosis group（P<0.05），
the difference in the above indicators between liver cirrhosis groupand healthy control groupwas not statistically significant. The
blood manganese in ACLF group and liver cirrhosis group was significantly higher than that in control group（P<0.05）. There
was no significant difference in vitamin B 1 ，vitamin B 6 ，25-hydroxyvitamin D，25-hydroxyvitamin D 3 ，blood manganese and
blood zinc between alcoholic liver disease subgroup and nonalcoholic liver disease subgroup（P>0.05）；the blood selenium in
alcoholic liver disease subgroup was significantly lower than that in nonalcoholic liver disease subgroup（P<0.05）. The levels of
25-hydroxyvitamin D，25-hydroxyvitamin D 3 were positively correlated with TBiL，INR，Child-Pugh score and MELD score，
and positively correlated with ALB level（P<0.05）. The levels of 25-hydroxyvitamin D and 25-hydroxyvitamin D 3 in Child-
Pugh grade C patients were lower than those in Child-Pugh grade A patients（P<0.05）. Conclusion In patients with liver
cirrhosis and ACLF，25-hydroxyvitamin D and 25-hydroxyvitamin D 3 are reduced，which is obviously related to the severity of
the disease；patients with liver cirrhosis and ACLF，especially those with alcoholic disease，have a significant decrease in blood
selenium，which can be supplemented as appropriate in clinical treatment.
【Key words】 End stage liver disease；Liver cirrhosis；Acute-on-chronic liver failure；Vitamins；Trace minerals

终末期肝病患者主要包括肝硬化、肝衰竭等，是临 亚组。选择年龄、性别无统计学差异的 5 例健康对照者
床常见的严重肝病症候群，病死率高。由于肝功能严重 为健康对照组，来源于本中心职工和研究生，没有明确
损伤、进食减少、吸收不良、储备减少等原因，终末期 病史且健康体检未见明确异常。
肝病患者常存在多种维生素和微量元素异常。由于维生 1.2 纳入与排除标准 纳入标准：（1）年龄 18~65 岁；
素和微量元素的检测在临床尚未普及，所以终末期肝病 （2）ACLF 诊断符合我国《肝衰竭诊治指南（2018 年
维生素和微量元素水平的确切情况尚不完全清楚，为临 版）》 ［1］ 中的相关标准；（3）肝硬化组患者依据病史、
床维生素和微量元素补充带来困难。本研究采用质谱 生化和影像学检查结果符合肝硬化临床诊断标准；（4）
方法对慢加急性肝衰竭（acute-on-chronic liver failure， 研究对象均知情同意并自愿参加研究。排除标准：（1）
ACLF）和肝硬化患者外周血 B 族维生素（维生素 B 1 和 合并严重感染；（2）合并肝癌等恶性肿瘤；（3）2 周
B 6 ）、25- 羟维生素 D、25- 羟维生素 D 3 以及微量元素锌、 内有活动性消化道出血；（4）2 周内应用过静脉或口
锰、硒水平进行了检测，以期进一步明确 ACLF 和肝硬 服维生素和微量元素制剂。
化患者外周血相应维生素和微量元素水平，进而为临床 本研究经过首都医科大学附属北京佑安医院伦理委
干预措施提供数据基础。 员会审核通过，伦理号：LL-2016-018-K。
1 资料与方法 1.3 检测方法 研究对象在入组第 2 天清晨空腹采血。
1.1 临床资料 选择 2020 年 9 月至 2021 年 5 月于首都 维生素（检测指标：维生素 B 1 、维生素 B 6 、25- 羟维生
医科大学附属北京佑安医院肝病中心四科住院的 ACLF 素 D、25- 羟维生素 D 3 ）：采血后 1 h 内分离血清，于 -80
患者 21 例为 ACLF 组，其中男 18 例、女 3 例，平均年 ℃冰箱中保存备用统一送检。检测方法：质谱法 LC-
龄（51.1±10.8）岁。并发症情况：腹腔积液 9 例，肝 MS/MS，仪器型号：waters TQD，仪器厂家：沃特世公司。
性脑病 7 例，胸腔积液 2 例。选择同期住院进行择期内 微量元素（检测指标：锰、锌、硒）：肝素抗凝管采血
镜下治疗或复查的代偿期肝硬化患者 9 例为肝硬化组， 后轻轻颠倒混匀 5~8 次，于 -80 ℃冰箱中保存备用统一
无并发症。ACLF 组和肝硬化组共 30 例，根据病因是否 送检。检测方法：质谱法 ICP-MS，仪器型号：安捷伦
为酒精性，进一步分为酒精性肝病亚组和非酒精性肝病 7800，仪器厂家：安捷伦公司。送检单位：杭州佰辰医