不同阶段乙型肝炎病毒感染者红细胞内外铁分布与肝纤维化的关系  

Relationship between iron distribution inside and outside erythrocytes and liver fibrosis in patients with HBV infection at different stages

作　　者：裴依菲 李艳 PEI Yi-fei;LI Yan(Clinical Laboratory,Pingmei Shenma Medical Group General Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]平煤神马医疗集团总医院医学检验科,河南平顶山467000

出　　处：《中国卫生检验杂志》2023年第9期1127-1130,1134,共5页Chinese Journal of Health Laboratory Technology

摘　　要：目的分析乙型肝炎病毒(HBV)慢性感染不同阶段患者红细胞内外铁分布失衡及其与肝纤维化指标的关系。方法选取2019年1月—2022年6月本院收治的慢性HBV感染患者300例,根据HBV感染的自然病程分为免疫耐受组(n=60)、免疫清除组(n=115)、免疫控制组(n=68)、再活动组(n=57)。测定所有患者肝功能指标[谷丙转氨酶(ALT)、冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)]、红细胞内外铁代谢指标[红细胞铁、红细胞外铁(铁蛋白、血清铁)],肝纤维化指标[层黏蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)、纤维结合蛋白(FN)],并进行比较,采用Pearson相关性分析红细胞内外铁代谢指标与肝纤维化指标相关性。结果4组患者ALT水平比较,再活动组>免疫清除组>免疫耐受组>免疫控制组(P<0.05),AST水平比较,免疫清除组>再活动组>免疫耐受组>免疫控制组(P<0.05),GGT水平比较,免疫耐受组、免疫清除组、再活动组均>免疫控制组(P<0.05);4组患者红细胞铁、铁蛋白、血清铁总体比较差异有统计学意义(P<0.05),进一步两两比较,红细胞铁水平再活动组、免疫控制组均<免疫清除组<免疫耐受组(P<0.05),铁蛋白及血清铁水平再活动组、免疫控制组均>免疫清除组>免疫耐受组(P<0.05);4组患者LN、HA、PCⅢ、CⅣ、FN差异均有统计学意义(P<0.05),进一步两两比较,再活动组、免疫控制组均>免疫清除组>免疫耐受组,差异均有统计学意义(P<0.05);Pearson相关性分析显示,LN、HA、PCⅢ、CⅣ、FN与红细胞铁均成负相关(P<0.05),与铁蛋白、血清铁均成正相关(P<0.05)。结论HBV慢性感染不同阶段伴随着红细胞内外铁代谢失衡及肝纤维化进程进行性加重,且红细胞内外铁代谢指标与肝纤维化指标之间存在明显的相关性。Objective This paper aims to analyze the imbalance of iron distribution inside and outside erythrocytes of patients with chronic hepatitis B virus(HBV)infection at different stages and its relationship with liver fibrosis indicators.Methods A total of 300 patients with chronic HBV infection treated in the hospital were selected between January 2019 and June 2022.According to the natural course of HBV infection,the patients were divided into immune tolerance group(n=60),immune clearance group(n=115),immune control group(n=68)and reactivation group(n=57).The liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptidase(GGT)],iron metabolism indicators inside and outside erythrocytes[erythrocyte iron,extra-erythrocyte iron(ferritin,serum iron)]and liver fibrosis indicators[laminin(LN),hyaluronic acid(HA),procollagen typeⅢ(PCⅢ),collagen typeⅣ(CⅣ),fibronectin(FN)]were determined among all patients and compared.Pearson correlation analysis was used to analyze the correlation between iron metabolism indicators inside and outside erythrocytes and liver fibrosis indicators.Results Among the four groups,comparison of ALT level showed a trend of reactivation group>immune clearance group>immune tolerance group>immune control group(P<0.05),AST level comparison showed a trend of immune clearance group>reactivation group>immune tolerance group>immune control group(P<0.05),and the GGT level of immune tolerance group,immune clearance group and reactivation group was higher than that of immune control group(P<0.05).There was statistical significance on the differences among the four groups in terms of erythrocyteiron,ferritin and serum iron(P<0.05).Further pairwise comparisons showed a trend of erythrocyte iron in reactivation group and immune control group<immune clearance group<immune tolerance group(P<0.05)and a trend of ferritin and serum iron in reactivation group and immune control group>immune clearance group>immune tolerance group,with the differences statistical

关 键 词：乙型肝炎病毒 慢性感染 红细胞 铁分布 肝纤维化 

分 类 号：R512.6[医药卫生—内科学]