| BackgroundThere are many factors which contribute to hepatic encephalopathy in cirrhotic patients: upper gastrointestinal bleeding;diuresis with a great number of potassium lost;running off ascitic fluid;high protein diet;giving sedatives or narcotic;constipation;uraemia;surgical intervention;infection;etc. But the predictive factors of hepatic encephalopathy have seldom to be mentioned. We deem that biochemical indicator combined with clinic is a preferable predictive factor.The protein in lipoprotein is called apolipoprotein(Apo). Apo has important physiological function in lipoprotein metabolism. It can constitute and stabilize the structure of the lipoprotein, modify enzyme related to lipoprotein metabolism and effect the enzymatic active, act as the ligand of lipoprotein receptor, and also can participate both combination of lipoprotein with lipoprotein receptor in cell surface and its metabolism.Serum Apo AI and Apo B is considered as protective factor and risk factor of atherosclerosis respectively. Some study has reported that the level of serum Apo AI and Apo B could reflect the pathophysiologic process of hepatic cirrhosis. But the relation between Apo and hepatic cirrhosis complicted by hepatic encephalopathy has not elucidated. To approaching the relation between Apo and hepatic encephalopathy, fathoming dynamic change of Apo in pre- and post-therapy, evaluating prognosis of HE patient, and to providing more clinic information, we try to use the level of serum Apo AI and Apo B as an indicator of hepatic cirrhosis complicted by hepatic encephalopathy.ObjectiveTo sieve influential factors of hepatic cirrhosis complicted by hepatic encephalopathy, approach especially the changing of the level of serum Apo AI and Apo B and its significance of dynamic detection.Material and method133 cirrhotic patients and 96 health examination people were recorded. Their clinic data and biochemical indicator were recorded respectively, especially serum level of Apo AI and Apo B. By logistic regression we compared cirrhotic group with health examination group, and compared decompensated cirrhotic group complicted by hepatic encephalopathy with uncompleted by hepatic encephalopathy. We approached the relation between the depression of serum Apo AI and Apo B and liver function impairment. And we also assessed various lipoprotein level in common complications of hepatic cirrhosis. Then we drew ROC curve and calculated the area under curveabout the serum level of Apo AI, Apo B, albumin and kalium ion. We matched part of cirrhotic patients complicated by hepatic encephalopathy pre- and post-therapy, and analyzed the change of the level of serum Apo AI and Apo B.Result1. Incidence of hepatic encephalopathy in cirrhotic patients: 28 of 133 cirrhotic patients have hepatic encephalopathy. The rate is 21.05%.2. After sieving influential factors of cirrhotic patients complicated by hepatic encephalopathy through logistic regression analysis of mono factor and multiple factor. We found that the risk factors of cirrhotic patients complicated by hepatic encephalopathy were infection;hyperbilimbinemia;hypercreatininernia;hypopotassaemia(OR= 15.115 ,P-0.040;OR= 1.055 JP=0.024;OR?1.071,P-0.051;OR-14.493JP=0.008), but the protective factors were Apo AI and albumin(OR-0.002,P=0.002;OR=0.636,P-0.006).3. When compared with control group, cirrhotic group have lower level of serum Apo AI( t -7.6 , P < 0.01) and Apo B( t = 6.2, P < 0.01).4. The area under ROC curve of Apo AI, Apo B, albumin, kalium ion(0.909, 0.649, 0.820, 0.770 respectively) indicate that the level of Apo AI is a preferable indicator for cirrhotic patients complicated by hepatic encephalopathy.5. The difference of Apo AI between Child-Pugh C and A,B has statistical significance(P<0.01). But the difference between A and B has no statistical significance. Apo B has nothing to do with Child-Pugh class.6. The level of Apo AI and Apo B of cirrhotic patients complicated by hepatic encephalopathy are lower than cirrhotic patients uncomplicated by hepatic encephalopathy. The difference has statistical significance(P<0.01). So it is an indicator for liver functional status like seralbumin and PT. The difference of the ratio of Apo Al/albumin between decompensated cirrhotic patients complicated by hepatic encephalopathy and uncomplicated by hepatic encephalopathy has notable statistical significance which hint that Apo AI decrease more obviously.7. The level of serum Apo AI decrement by turns in below common complications of cirrhosis: ascites, alimentary tract hemorrhage, infection and hepatic encephalopathy. When the level drop to 50" 60% normal value, it is easy to be complicated by hepatic encephalopathy.8. After 2 weeks therapy, the level of serum Apo AI in 15 of 24 cirrhotic patients complicated by hepatic encephalopathy upgrade(P<0.01),but the the level of serum Apo AI of 9 decrease(P<0.05). The difference of Apo B has no statistically significant.Conclusion(1) Risk factors of cirrhotic patients complicated by hepatic encephalopathy are infection;hyperbilirubinemia;hypercreatininemia;hypopotassaemia. protective factors maybe Apo AI and albumin.(2) The serum level of Apo AI is high related to Child-Pugh class, but Apo B may has nothing to do with Child-Pugh class.(3) The level of serum Apo AI decrement by turns in below common complications of cirrhosis: ascites, alimentary tract hemorrhage, infection and hepatic encephalopathy whichindicate that Apo AI is a preferable indicator for cirrhotic patients complicated by hepatic encephalopathy.(4) Dynamic detecting of Apo AI maybe helpful to judge prognosis of hepatic encephalopathy and maybe helpful to diagnosis and therapy of hepatic encephalopathy when combined with clinic. But Apo B doesn't act like this.(5) This study is case control study and stay to be testified by prospective study. It is need more data to manifest causal relation of degression of Apo AI and hepatic encephalopathy, and to identify whether Apo AI is an independent risk factor for contribute to hepatic encephalopathy. |
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