血氨水平与肝纤维化指标的变化在肝硬化合并肝癌无创伤诊断的相关性分析  

Correlation analysis of non-invasive diagnosis between the level of plasma ammonia and the change of serum fibrosis markers in patients with liver cirrhosis and hepatocellular carcinoma

作　　者：叶迎宾 郭卫刚[1] 柴广丽[1] 章健[1] 田楠楠[1] 王晓芳[1] 黄秀香[1] 李友生[1] 

机构地区：[1]河北省邯郸市传染病医院,056002

出　　处：《山西医药杂志（下半月）》2013年第7期744-746,共3页Shanxi Medical Journal

摘　　要：目的探讨肝硬化合并肝癌患者血氨水平和肝纤维化标志物变化与肝功能Child-Pugh分级间的相关性。方法选取108例肝硬化合并肝癌患者(肝癌组)和健康对照组67名。采用化学发光法检测透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C),血氨采用连续监测法。比较肝癌组与对照组、肝癌组Child-Pugh分级间的血氨水平与肝纤维化指标的变化。结果与对照组相比,肝癌患者血氨、HA、LN、PC-Ⅲ和Ⅳ-C均升高,差异有统计学意义(P<0.01)。随着Child-Pugh等级上升,其血氨、HA、LN、PC-Ⅲ和Ⅳ-C逐渐升高,分级间比较差异有统计学意义(P<0.01)。肝癌患者随着肝功能的下降,血氨与LN呈正相关(r=0.5562、0.690、0.3423,P<0.05),与HA、PC-Ⅲ、Ⅳ-C无相关性。结论血氨水平和肝纤维化指标变化对肝硬化合并肝癌无创伤诊断有一定的临床意义。Objective To explore the level of plasma ammonia and the change of serum fibrosis markers in patients with liver cirrhosis and hepatocellular carcinoma,and their correlation with the Child-Pugh score in liver cirrhosis.Methods A total of 108 patients with hepatic cirrhosis and liver cancer were enrolled.They were divided into three subgroups（A,B,and C）on the basis of Child-Pugh classification. Sixty-seven healthy individuals served as controls.Serum hyaluronic acid（HA）,laminin（LN）,type Ⅲ procollagen（PC-Ⅲ） and type Ⅳ collagen（Ⅳ-C）were determined by chemiluminescence and plasma ammonia （NH3） was determined by continuous monitoring method. To compare the level of NH3 and the change of serum fibrosis markers in the liver cancer and control groups,also between Child-Pugh classification in liver cancer groups.Results Compared with the control group, NH3, HA, LN, PC-Ⅲ and Ⅳ-C increased in patients with cancer of the liver, there were significant difference between the two groups （P0.01）. NH3, HA, LN, PC-Ⅲ and Ⅳ-C increased ,with the increase of the Child-Pugh grades,there were significant difference between the three groups （P0.01）. NH3 and LN was positively correlated with the decline in liver function （r=0.556 2, 0.690, 0.342 3,P0.05）.NH3 was of no significant correlation with HA, PC-Ⅲ, and Ⅳ-C. Conclusion The level of plasma ammonia and the change of serum fibrosis markers have the certain clinical significance regarding the non-invasive diagnosis in liver cirrhosis and hepatocellular carcinoma patients.

关 键 词：透明质酸 层黏连蛋白 胶原Ⅳ型 胶原Ⅲ型 肝硬化 肝肿瘤 

分 类 号：R512.6[医药卫生—内科学]