标题：RDW、血清OPN在肝硬化病程及Child-pugh分级中的应用

      作者：李韫池 1，2，史也 1，2，孙中磊 1，3，田蕾 1    1.锦州医科大学研究生学院，辽宁 锦州 121000；2.辽阳市中心医院消化内科，辽宁 辽阳 111000；3.枣庄矿业集团中心医院消化内科，山东 枣庄 277400

      卷次： 2020年31卷22期

      【摘要】 目的 探索骨桥蛋白(OPN)、红细胞分布宽度(RDW)与肝硬化病程及Child-pugh分级的关系及临床意义。方法 选取2017年11月至2019年7月于辽阳市中心医院诊断为肝硬化患者87例作为肝硬化组，选取87例同期健康体检的健康人群作为对照组。收集两组受检者的血常规、生化系列、凝血功能及血清OPN指标，比较不同肝硬化分组患者OPN、RDW的变化情况，采用Pearson相关性和单因素方差分析OPN、RDW与肝硬化病程及肝功能Child-Pugh分级的关系。结果 肝硬化组患者RDW、OPN、AST、ALT、GGT、TBil、PT、FIB等指标均明显高于对照组，而RBC、Hb、PLT及Alb等指标则明显低于对照组，差异均有统计学意义(P<0.05)；按肝硬化贫血程度分组，重度贫血组与轻中度贫血组和无贫血组的OPN [(141.56±36.27) ng/mL vs (113.57±32.56) ng/mL vs (82.75±22.64) ng/mL]、RDW [(17.64±2.52)% vs (15.95±1.85)% vs (14.65±2.16)%]比较，重度贫血组明显高于轻中度贫血组和无贫血组，差异均具有统计学意义(P<0.05)；按肝硬化病程分组，肝功能失代偿期组与肝功能代偿组和对照组的 OPN[(133.65±31.57) ng/mL vs (97.53±28.64) ng/mL vs (26.71±4.85) ng/mL]、RDW [(16.11±2.25)% vs (14.75±2.13)% vs(13.71±1.96)%]比较，肝功能失代偿期组明显高于肝功能代偿组和对照组，差异均有统计学意义(P<0.05)；OPN、RDW与谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBil)、凝血酶原时间(PT)均呈正相关(P<0.05)，但与白蛋白(Alb)、纤维蛋白原(FIB)指标均呈负相关(P<0.05)；按肝硬化Child-Pugh分级分组，A组、B组和C组的OPN、RDW值比较差异具有统计学意义(P<0.05)，并与Child-Pugh分级评分呈正相关(P<0.05)；而按肝硬化病因分组，酒精性肝硬化组、肝炎性肝硬化组和其他病因肝硬化组的OPN、RDW值比较差异无统计学意义(P>0.05)。结论 OPN与RDW联合检测可作为预测肝硬化病程的指标，可反映贫血、消化道出血等相关并发症的严重程度，并可作为辅助Child-Pugh分级的一项指标，但尚无法用于鉴别肝硬化病因。
      【关键词】 肝硬化；骨桥蛋白；红细胞分布宽度；Child-pugh分级；肝功能
      【中图分类号】 R575.2 【文献标识码】 A 【文章编号】 1003—6350（2020）22—2884—05

Application of serum osteopontin and red blood cell distribution width in the course of liver cirrhosis andchild-pugh classification.
LI Yun-chi 1,2, SHI Ye 1,2, SUN Zhong-lei 1,3, TIAN Lei 1. 1.Graduate School, Jinzhou MedicalUniversity, Jinzhou 121000, Liaoning, CHINA; 2. Department of Digestive Disease, Liaoyang Central Hospital, Liaoyang111000, Liaoning, CHINA; 3. Department of Digestive Disease, Zaozhuang Mining Group Central Hospital, Zaozhuang277400, Shandong, CHINA
【Abstract】 Objective To explore the relationship between osteopontin (OPN), red blood cell distributionwidth (RDW) and the course of liver cirrhosis and child-Pugh grading. Methods Eighty-seven patients with liver cir-rhosis diagnosed in Liaoyang Central Hospital from November 2017 to July 2019 were selected as the cirrhosis group,and 87 healthy people in the same period were selected as the control group. Blood routine test, biochemical series, coag-ulation function, and serum OPN indexes of the two groups were collected. The changes of OPN and RDW in patientswith different cirrhosis groups were compared. Pearson correlation and one-way ANOVA were used to analyze the rela-tionship between OPN, RDW and the course of cirrhosis, child Pugh grade of liver function. Results RDW, OPN, as-partate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), total bilirubin(TBil), prothrombin time (PT), fibrinogen (FIB) of liver cirrhosis group were significantly higher than those of controlgroup, while red blood cell (RBC), hemoglobin (Hb), platelet (PLT), and albumin (ALB) were significantly lower thanthose of control group (P<0.05). According to the degree of liver cirrhosis anemia, OPN, RDW of severe anemia groupwere (141.56 ± 36.27) ng/mL, (17.64 ± 2.52)% , which were significantly higher than (113.57 ± 32.56) ng/mL, (15.95 ±1.85)% in mild to moderate anemia group and (82.75±22.64) ng/mL, (14.65±2.16)% in nonanemia group (P<0.05). Ac-cording to the course of cirrhosis, OPN, RDW in decompensated liver function group were (133.65 ± 31.57) ng/mL,