探讨肝硬化患者血清肌酸激酶(CK)、肌酸激酶同工酶-MB(CK-MB)水平与Child-Pugh评分的相关性。

分析2013年4—7月确诊的肝硬化患者临床资料。入选标准：(1)肝硬化诊断符合全国传染病与寄生虫病防治学术会议诊断标准；(2)既往无冠心病、高血压、心肌病病史；(3)心电图无ST-T动态变化；(4)cTnI正常。排除标准：(1)脾脏切除史；(2)合并肝癌，肝移植者，进行干扰素、免疫抑制剂或抗病毒治疗者；(3)存在血液系统疾病或严重感染性疾病。对患者入院进行Child-Pugh分级测评，记录各组患者临床基线资料，包括年龄、性别、原发肝脏疾病、肝功能、血常规等，分别采用酶动力法和免疫抑制法，检测入选患者的CK和CK-MB水平。比较患者CK、CK-MB水平及CK-MB/CK比值，采用有序Logistic回归分析肝硬化患者CK-MB/CK比值与Child-Pugh评分之间的相关性。

总共入选符合标准的肝硬化患者121例，平均年龄(56.67±10.88)岁，其中男性89例，乙肝肝硬化患者72例。Child-Pugh C级患者年龄明显高于Child-Pugh A、B组患者(P＝ 0.021)，3组患者γ-谷酰转肽酶、CK[(82.18±23.60)U/L、(98.22±33.13)U/L、(117.05±27.31)U/L，F＝23.248，P<0.01)]、CK-MB[(29.77±12.75)U/L、(63.26±36.35)U/L、(69.76±27.05)U/L、F＝20.588，P<0.05)]、CK-MB/CK比值(0.36±0.08、0.54±0.26、0.75±0.30，F＝31.558，P<0.05)、凝血酶原活动度(PA)[(71.77±14.88)%、(56.82±16.61)%、(41.73±11.43)%，F＝54.483，P<0.05)]、血红蛋白(HGB)[(138.21±8.24)g/L、(108.16±23.60)g/L、(78.52±23.64)g/L，F＝95.752，P<0.05)]以及血小板(PLT)[(153.86±92.59)g/L、(108.38±51.90)g/L、(93.88±54.51)g/L，F＝12.965，P<0.05)]水平差异均有统计学意义。3组患者原发肝脏疾病、谷草转氨酶(ALT)、谷丙转氨酶(AST)以及肌酐水平(SCr)差异均无统计学意义。对资料进行有序Logistic回归分析，发现CK-MB/CK比值对Child-Pugh评分有显著影响，其OR值为e^－0.98＝0.375，提示CK-MB/CK比值>0.30时，Child-Pugh分级C级的可能性为CK-MB/CK<0.30时的2.67倍。

肝硬化患者CK-MB/CK比值与Child-Pugh分级严重程度密切相关。

The aim of this study was to analyze the relationship of ratio of CK-MB/CK on Child-Pugh classification in patients with cirrhosis.

The patients with cirrhosis who admitted to our hospital from April 2013 to July 2013 were enrolled in this study.A total of 121 cases were enrolled in this study, average age was 56.67±10.88 years old, with 89 of whom were male and 72 of whom were hepatitis B cirrhosis.The Child-Pugh score was used to assess the prognosis of cirrhosis, and patients were classified into Child-Pugh class A to C. Inclusion criteria included: (1)diagnosis of cirrhosis was made according to the National Infectious and Parasitic Diseases Conference; (2)no previous histories of coronary heart disease, hypertension or heart disease; (3)without ST-T changes in electrocardiogram; (4)the levels of cTnI was normal. Exclusion criteria included: (1)history of splenectomy; (2)hepatocellular carcinoma, liver transplant, carried interferon, immunosuppressive or anti-viral treatment; (3)the presence of blood diseases or serious infectious diseases. Baseline clinical characteristics including age, gender distribution, hepatic functions and routine examinations were recorded. The kinetic enzymatic method and immunosuppression method were used to measure the levels of CK and CK-MB respectively. The levels of CK and CK-MB, as well as ratios of CK-MB/CK were compared among groups. Ordinal Logistic regression analysis was used to analyze the relationship of CK-MB/CK ratio on Child-Pugh classification.

Patients in Child-Pugh C group were older than those in Child-Pugh A and B groups (P=0.021). There were significant differences in γ-GT(195.61±20.32, 240.56±27.23, 265.15±17.48, F=77.149, P<0.05), CK[(82.18±23.60)U/L, (98.22±33.13)U/L, (117.05±27.31)U/L, F=23.248, P<0.05)], CK-MB[(29.77±12.75)U/L, (63.26±36.35)U/L, (69.76±27.05)U/L, F=20.588, P<0.05)], ratio of CK-MB/CK(0.36±0.08, 0.54±0.26, 0.75±0.30, F=31.558, P<0.01), prothrombin activity[(71.77±14.88)%, (56.82±16.61)%, (41.73±11.43)%, F=54.483, P<0.05)], hemoglobin[(138.21±8.24)g/L, (108.16±23.60)g/L, (78.52±23.64)g/L, F=95.752, P<0.05)] and platelet[(153.86±92.59)g/L, (108.38±51.90)g/L, (93.88±54.51)g/L, F=12.965, P<0.05)] among groups. No significances in gender distribution, hepatic diseases, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Creatinine (SCr) were found among groups in this study. Ordinal Logistic regression analysis found that there was a relationship of CK-MB/CK ratio on Child-Pugh classification in patients with cirrhosis, with the value of OR was e^{- 0.98}=0.375. This result indicated that the probability of Child-Pugh C in cirrhosis patients with the value of CK-MB/CK>0.30 was 2.67 times higher than those when less than 0.30.

The ratio of CK-MB/CK is significantly associated with Child-Pugh classification in patients with cirrhosis.