郑强，刘世平，贾家猛，彭泰峦，王贤芝，周程继

(川北医学院附属医院急诊科,四川 南充　637000)



联合检测血氨与血清色氨酸在急诊肝性脑病患者中的临床应用

郑强，刘世平，贾家猛，彭泰峦，王贤芝，周程继

(川北医学院附属医院急诊科,四川 南充637000)

目的：探讨联合检测血氨和血清色氨酸在急诊诊断及鉴别诊断肝性脑病的临床应用价值。方法：收集本院急诊科95例精神障碍患者，其中实验组肝性脑病患者55例，以非肝性脑病患者40例作为对照组，分别检测两组患者的血氨、血清色氨酸(血清游离色氨酸 FT、总色氨酸 TT)、肝功能(ALT、AST，TP、ALB、TBil、DBil、GGT、ALP)。结果：实验组中的肝功(ALT、AST，TP、ALB、TBil、DBil、GGT、ALP)、血氨、FT及TT测定结果均高于对照组(P<0.05)；血氨、FT及TT三项联合检测的敏感度、符合率和正确诊断指数均高于其三者的单独测定值(P<0.05)；血氨、FT及TT三项联合检测的漏诊率低于其三者的单独测定值(P<0.05)；血氨、FT及TT三项联合检测的特异度与三者的单独测定的特异度相比，不具有统计学意义(P>0.05)；在ROC曲线中，三项联合检测的AUC高于单独测定的血氨AUC、FT AUC与TT AUC(P<0.05)。结论：在急诊医学中对于由于肝性脑病引起的精神障碍患者，除了常规的实验室检测肝功及血氨外，还应联合检测血清色氨酸以提高诊断及鉴别诊断肝性脑病的灵敏度、符合率和诊断指数，降低漏诊率，有利于肝性脑病患者得到及时的诊断及早期的治疗，以便患者早日康复。

血氨；血清游离色氨酸；总色氨酸；肝性脑病

【Abstract】Objective：To explore the clinical application value of combined determination of serum tryptophan and blood ammonia in diagnosis and differential diagnosis of acute hepatic encephalopathy.Methods：We collected 95 cases of patients with mental disorders in the emergency department of our hospital,including 55 patients with hepatic encephalopathy,40 patients with non hepatic encephalopathy.Serum tryptophan(FT,TT),blood ammonia,liver function (ALT,AST,TP,ALB,TBil,DBil,GGT,ALP)were detected in the two groups.Results：The results of liver function (ALT,AST,TP,ALB,TBil,DBil,GGT,ALP),blood ammonia,FT and TT in the experimental group was high than the control group (P<0.05);The sensitivity,coincidence rate and correct diagnosis index of three joint detection of blood ammonia,FT and TT were higher than those of separate test value of the three(P<0.05);The rate of missed diagnosis of blood ammonia,FT and TT was lower than those of the three(P<0.05);The specificity of the three combined detection was compared with those of the three alone,there have no statistical significance.(P>0.05);In the ROC curve,three joint detection AUC higher than the separate test in Blood ammonia AUC，FT AUC and TT AUC (P<0.05).Conclusion：In emergency medicine due to hepatic encephalopathy caused mental disorders,in addition to the routine laboratory tests of liver function and blood ammonia,should also combined detection of serum tryptophan to improve the sensitivity of diagnosis and differential diagnosis of hepatic encephalopathy,coincidence rate and index of diagnosis,reduce the rate of misdiagnosis.It is beneficial to the diagnosis and early treatment of hepatic encephalopathy,so that patients can recover soon.

【Key words】Blood ammonia;FT;TT;Hepatic encephalopathy

肝性脑病(hepatie encephalopathy，HE)是急诊科常见的精神障碍疾病，其临床表现主要以意识行为改变或昏迷为主，临床上诊断肝性脑病及鉴别诊断主要依靠临床表现及实验室检测血氨、肝功能指标[1-2]，血氨测定虽然是急诊肝性脑病患者诊断及鉴别诊断的主要指标，但是其敏感度并不高[3]。肝性脑病患者除有血氨增高外，尚有血清游离色氨酸(FT)和总色氨酸(TT)的变化[4]，然而现代医学由于种种原因，却未将FT及TT的测定加入到诊断及鉴别诊断肝性脑病的常规检测中。肝性脑病的发生与患者血清色氨酸和血氨代谢紊乱密切相关，本实验通过检测肝性脑病患者与其他精神障碍患者的血氨、FT、TT来探讨其联合检测在急诊肝性脑病患者中的临床应用价值。……