摘要目的：探讨肝功能衰竭患者血清铁相关指标的变化及预测近期预后的价值。方法比较89例肝功能衰竭患者和30例慢性病毒性肝炎患者血清铁相关指标水平，血清铁采用络合法检测，铁蛋白和转铁蛋白采用免疫比浊法检测，记录所有患者入院24 h 血常规、部分生物化学指标、凝血指标，计算终末期肝病模型（MELD）评分，并随访患者12周时预后。统计学处理采用 t 检验，多变量相关分析采用 Logistic 多元回归分析。结果肝功能衰竭患者和慢性肝炎患者，血清铁分别为（29．85±13．34）和（27．98±12．54）μmol／L，差异无统计学意义（t＝0．672，P ＝0．503）。血清转铁蛋白分别为（1．52±0．41）和（2．77±0．60）g／L，差异有统计学意义（t＝－12．762，P ＝0．000）；血清转铁蛋白与白蛋白、胆碱酯酶、胆固醇呈正相关。血清铁蛋白分别为（897．55±541．97）和（333．06±193．48）μg／L，差异有统计学意义（t＝5．573，P ＝0．000）；血清铁蛋白与 ALT、AST、TBil 呈正相关，与 PTA 呈负相关。Logistic 多元回归分析显示，MELD、血清铁蛋白为影响肝功能衰竭患者12周预后的独立危险因素。血清铁蛋白、MELD和 MELD-铁蛋白联合判断肝功能衰竭患者12周预后的受试者工作特征曲线下面积（AUC）分别为0．722、0．791和0．818。结论肝功能衰竭患者血清铁水平正常，但转铁蛋白明显低于正常，血清铁蛋白明显升高。

abstractsObjective To investigate the dynamic changes of serum iron related parameters and the predictive value for prognosis in patients with liver failure.Methods Serum iron related parameters were compared between 89 cases with liver failure and 30 cases with chronic viral hepatitis.Serum iron was detected by complex method.Ferritin and transferrin were measured by immunoturbidimetry.Routine blood test,biochemical indexes,blood coagulation index as well as model for end-stage live diseases (MELD)score within 24 hours of hospitalization were all recorded.All patients were followed up for 12 weeks.Two sample t-test was used to analyze continuous variables.Logistic multiple regression analysis was used to perform multivariate correlation analysis.Results Serum iron levels in patients with liver failure and chronic viral hepatitis were (29.85 ± 13.34 )μmol/L and (27.98 ± 12.54 )μmol/L, respectively,which were not significantly different (t =0.672,P =0.503 ).Serum transferrin levels in two groups were (1 .52±0.41)g/L and (2.77 ±0.60)g/L,respectively,with no significant difference. Transferrin was positively correlated with Alb,CHE and CHO.Serum ferritin levels were significantly different between patients with liver failure and chronic viral hepatitis [(897.55 ±541 .97)vs (333.06 ± 193.48)μg/L,t=5 .573,P =0.000].Ferritin was positively correlated with ALT,AST and TBil,but negatively correlated with PTA.Multiple logistic analysis showed that MELD score and serum ferritin were independent risk factors for 12-week prognosis of patients with liver failure.Areas under curves of ferritin,MELD and MELD combined with ferritin to predict the prognosis were 0.722,0.791 and 0.818,respectively.Conclusions In patients with liver failure,serum iron level is within normal range,while serum transferrin is significantly decreased and the serum ferritin is elevated.