血清同型半胱氨酸、叶酸、亚甲基四氢叶酸还原酶与HBV感染后疾病进展关系的研究  

Relationship of plasma levels of homocysteine, methylenetetrahydrofolate reductase and folate with outcome of HBV infection

作　　者：焦晓磊[1] 高英堂[1] 景丽[1] 王瑞[1] 刘娟娟[2] 许彦杰[1] 杜智[1] 

机构地区：[1]天津市第三中心医院,天津市人工细胞重点实验室,天津300170 [2]保定市第二医院检验科,河北保定071051

出　　处：《生物医学工程与临床》2013年第6期595-600,共6页Biomedical Engineering and Clinical Medicine

基　　金：天津市卫生局攻关项目(11KG112)

摘　　要：目的分析不同进展阶段乙型肝炎病毒（HBV）感染者血清中同型半胱氨酸（HCY）、叶酸和亚甲基四氢叶酸还原酶（MTHFR）的水平、相关性及其与肝病进展的关系。方法按照性别、年龄和基因型均匹配的原则挑选乙型肝炎自愈组（男性15例，女性15例；年龄37～66岁，平均年龄52．90岁）、肝硬化组（男性15例，女性15例：年龄36-73岁，平均年龄54.87岁）和肝癌组（男性15例，女性15例：年龄38～78岁．平均年龄56．37岁）研究对象各30例，采用酶联免疫吸附分析（ELISA）检测试剂盒检测血清HCY、MTHFR和叶酸的水平。结果血清叶酸和MTHFR水平在自愈组中显著高于肝硬化组和肝癌组（P〈0．01）。3个血清学指标的相关性分析显示，叶酸和MTHFR在各组均呈显著的正相关（P〈0．01）：在肝癌组中，HCY与叶酸和MTHFR也具有显著的正相关关系（P〈0．01）。3个指标在终末期肝脏疾病患者（肝癌组和肝硬化组）不同临床特征的组别间分层分析显示，随着肝功能下降，血清HCY水平增高，且差异具有统计学意义（P〈0．05）：HBsAg（-）和HBVDNA（〈500copies／mL）的终末期肝病患者血清MTHFR和叶酸水平分别高于HBsA（＋1）和HBVDNA（≥500copies／mL）者（P〈0．05）。结论男性、血清叶酸和MTHFR浓度降低是HBv感染后疾病恶性进展的风险因素。Objective To investigate the correlations of homocysteine （HCY）, methylenetetrahydrofolate reductase （MTHFR） and folate and their influence on the outcome of patients affected by hepatitis B virus （HBV）. Methods Ninety patients with HBV- related liver diseases were enrolled, included 30 self-limited infectors, 15 males and 15 females, which were aged 37 - 66 years old with a mean age of 52.90; 30 HBV-induced liver cirrhosis, 15 males and 15 females, which were aged 36 - 73 years old with a mean age of 54.87; and 30 HBV-related hepatoeellular eareinoma（HCC）, 15 males and 15 females, which were aged 38 - 78 years old with a mean age of 56.37. The total serum levels of HCY, MTHFR and folate were assayed by enzyme-linked immunosorbent assay （ELISA）. Results The serum levels of MTHFR and folate were significantly higher in self-limited patients than that in HBV- related liver cirrhosis and HCC（P〈 0.01）. Serological assay showed that there was significant correlation between MTHFR and folate （P 〈 0.01）. Serum HCY correlated with MTHFR and folate in HCC subjeets（P 〈 0.01）, but not in healthy and self-limited subjects. Furthermore, analysis of plasma levels of these parameters showed that homoeysteine increased with the impairment of liver function （P 〈 0.05）. In patients with end-stage liver disease, the serum levels of MTHFR and folate in patients with HBsAg（-） and lower HBV DNA （〈 500 eopies/mL） were higher than that in patients with HBsAg （＋） and higher HBV DNA （≥ 500 eopie/mL）（P 〈 0.05）. Conclusion It is demonstrated that the HBV-infected male, low levels of serum MTHFR and folate tend to increase the risk of liver malignanee, while high levels of these may contribute to virus clearance or disease recovery..

关 键 词：同型半胱氨酸 亚甲基四氢叶酸还原酶 叶酸 乙型肝炎病毒感染 肝癌 肝硬化 

分 类 号：R512.62[医药卫生—内科学]