肝炎肝硬化患者血清胃泌素的变化  

The change of serum gastrin in patients with post-hepatitis cirrhosis

作　　者：边新渠[1] 张月宁[1] 熊峰[1] 吴燕京[1] 米军[1] 张世斌[1] 金瑞[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝病免疫科,100069

出　　处：《北京医学》2017年第9期914-918,共5页Beijing Medical Journal

摘　　要：目的探讨肝炎肝硬化患者外周血清胃泌素的变化特点,以及幽门螺杆菌(Hp)感染对血清胃泌素的影响及其临床意义。方法选择首都医科大学附属北京佑安医院确诊的肝炎肝硬化患者165例[男113例,女52例,平均年龄(51.9±11.4)岁]及同期健康志愿者30例[男12例,女18例,平均年龄(44.9±11.9岁)]作为研究对象。肝炎肝硬化组分为Child-Pugh A级(54例)、B级(60例)、C(51例)。抽取外周静脉血3 ml、行^(14)C-尿素呼气试验和电子胃镜检查(结果由两名以上专业人员诊断)。根据胃镜下活检病理和14C-尿素呼气试验判断是否Hp感染。双抗体夹心酶联免疫吸附实验检测血清胃泌素浓度,并根据标准曲线计算胃泌素含量。以肝炎肝硬化患者胃泌素水平为因变量,Hp感染情况、性别、年龄、病毒载量、总胆红素、肌酐、白蛋白、血氨、血浆凝血酶原时间、溃疡情况、静脉曲张情况为自变量进行多元逐步回归分析。结果 165例肝炎肝硬化患者中Hp感染率48.5%(80/165);Child-Pugh A、B、C级Hp感染率分别为40.7%(22/54)、50.0%(30/60)、54.9%(28/51),差异无统计学意义(P=0.335)。30例对照组Hp感染率20.0%(6/30),显著低于肝炎肝硬化组(P=0.004)。肝炎肝硬化组血清胃泌素的浓度为(772.9±368.3)pg/ml,高于对照组(260.3±117.6)pg/ml,差异有统计学意义(P<0.01)。肝炎肝硬化Hp感染者血清胃泌素平均浓度(957.2±318.5)pg/ml显著高于未感染者(595.1±324.2)pg/ml,差异有统计学意义(P<0.01)。进一步分组比较,Child A、B、C各亚组Hp感染者比未感染者的血清胃泌素浓度均亦显著升高[(781.3±233.8)pg/ml vs.(398.0±159.3)pg/ml,(884.2±235.9)pg/ml vs.(617.6±301.8)pg/ml,(1 205.9±316.5)pg/ml vs.(816.6±334.9)pg/ml,P均<0.01]。多元逐步回归分析,Hp感染对肝炎肝硬化患者血清胃泌素水平的影响最大,白蛋白水平与胃泌素水平呈负相关。肝炎肝硬化并发消化性溃疡50例,占30.3%。肝炎肝硬化合并消化Objective To explore the effect of Helicobacter pylori（Hp） on serum gastrin in patients with post-hepatitis cirrhosis and its clinical significance by investigating the level of serum gastrin in patients with post-hepatitis cirrhosis with or without Hp infection. Methods A total of 165 patients [ 113 males and 52 females, average age（ 51.9± 11.4） years old] with post-hepatitis cirrho- sis diagnosed and 30 volunteers [ 12 males and 18 females, average age（44.9±11.9） years old] from April to December, 2009 were en- rolled. The cirrhotic patients included 54 cases of Child-Pugh A,60 cases of Child-Pugh B and 51 cases of Child-Pugh C. Venous blood was collected and gastroendoscope and 14C-UBT were performed. Hp infection was confirmed by Giemsa staining and the re- suits of J4C-UBT. Enzyme-linked immunosorbent assay was used to detect the serum gastrin concentration of cirrhotic patients. Multi- ple linear regression analysis was done by dependent variable （gastrin） and predictors （Hp, gender, age, the amount of virus, total bili- rubin, creatinine, serum albumin, plasma ammonia, plasma prothrombin time, peptic ulcer, esophageal varices）. Results Hp could be found in 80 cirrhotic patients （48.5%, 80/165）, of which 22 cases were in Child-Pugh A sub-group （40.7%, 22/54）, 30 cases in Child-Pugh B group （50.0%, 30/60） and 28 cases in Child-Pugh C group （54.9%, 28/51）, respectively. The positive rate of Hp infec- tion in the control group was 20.0% （6/30）, which was significantly lower than that of the cirrhotic group（P = 0.004）. The concentra- tion of serum gastrin in cirrhotic patients was notably higher than that in the control group [（772.9±368.3）pg/ml vs. （ 260.3± 117.6）pg/ ml, P 〈 0.01 ]. Similarly, there was a marked difference between cirrhotic patients with and without Hp infection [（957.2±318.5）pg/ml vs. （595. 1±324.2）pg/ml, P 〈 0.01 ], and between cirrhotic patients in each sub-group with and without Hp infection[ （781.3±233.8）pg/ml vs.�

关 键 词：胃泌素 幽门螺杆菌 肝炎肝硬化 消化性溃疡 

分 类 号：R575[医药卫生—消化系统]