慢性乙型肝炎患者血清中α1微球蛋白检测的临床意义

发布时间：2018-01-06 04:26

本文关键词：慢性乙型肝炎患者血清中α1微球蛋白检测的临床意义　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:慢性乙型病毒性肝炎(chronic hepatitis B,CHB)是由乙型肝炎病毒(hepatitis Bvirus,HBV)感染引起的一种传染性疾病,极易慢性化,并最终演化为肝硬化与肝细胞癌。全球约有4亿人为慢性HBV携带者,近30%的世界人口感染或曾经感染过HBV。2006年全国乙肝流行病学调查表明,我国1~59岁一般人群乙肝病毒携带率为7.18%,5岁以下儿童0.96%,现有慢性HBV感染者约9300万人,其中慢性乙肝患者约2000万人。早期发现病毒性肝炎患者的肝损害程度十分重要,目前检测肝脏功能的指标很多,但都很难准确客观地反映肝脏的功能状况。α1微球蛋白(alpha 1-microglobulin,α1-MG)为相对分子质量26 000~33 000的小分子糖蛋白,在体内分布广泛,主要由肝细胞特异性合成后,随血液运输分配到体内各种组织中,具有重要的生理作用。目的:本文通过检测243例CHB患者血清ɑ1-MG的水平,并与其他常用肝功能指标进行比较,以探讨其在CHB患者中检测的临床意义。方法:将243例CHB患者分为肝肾功能正常组、肝功能正常肾功能异常组、肝功能异常肾功能正常组和肝肾功能异常组,同时选取67名健康体检者作为对照组,测定各组受试者血清ɑ1-MG水平,同时测定丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)等肝功能指标及肌酐(CREA)、尿素氮(BUN)等肾功能指标。ɑ1-MG检测采用免疫比浊法,ALT采用紫外-乳酸脱氢酶法,AST采用紫外-苹果酸脱氢酶法,ALP采用AMP缓冲液法,CREA采用肌氨酸氧化酶法,BUN采用紫外-谷氨酸脱氢酶法。结果:与对照组比较,肝功能异常肾功能正常组患者血清ɑ1-MG水平明显降低(P0.05),肝肾功能正常组和肝肾功能异常组患者血清ɑ1-MG水平无明显变化(P0.05),肝功能正常肾功能异常组患者血清ɑ1-MG水平明显升高(P0.01)。按照ɑ1-MG10 mg·L-1为判断肝功能异常的标准,肝功能异常肾功能正常组患者血清ɑ1-MG阳性率为36%,肝肾功能异常组患者血清ɑ1-MG阳性率为24%;如以ɑ1-MG15 mg·L-1为标准,则肝功能异常肾功能正常组患者血清ɑ1-MG阳性率为68%。肝功能异常肾功能正常组患者血清ɑ1-MG水平与肝功能指标ALT、AST及ALP呈负相关关系(r=-0.934,r=-0.916,r=-0.847,P0.01),且其数值随着肝损伤程度的加重而降低。结论:肝肾功能正常的CHB患者血清ɑ1-MG水平略低于正常对照组,但与对照组无显著差异;肝功能正常肾功能异常组患者血清ɑ1-MG水平高于正常对照组,即肾功能损害时血清ɑ1-MG增高;肝功能异常时,CHB患者血清ɑ1-MG的水平根据肾功能是否异常而不同。如合并肾功能异常,则ɑ1-MG的水平与对照组比较无显著差别;如肾功能正常,则ɑ1-MG水平显著降低;ɑ1-MG与ALT及AST呈显著负相关。以ɑ1-MG15 mg·L-1为判断肝功能异常的标准,单纯肝功能异常时的阳性率为68%,ɑ1-MG是检测CHB患者肝功能的一个有效的指标,但临床上应用时须排除肾功能损害引起的结果干扰。HBV DNA低载量组及HBV DNA高载量组ɑ1-MG水平差异不显著,ɑ1-MG水平似乎和肝炎病毒感染无直接关系。
[Abstract]:Background: chronic hepatitis B (chronic hepatitis, B, CHB) is caused by the hepatitis B virus (hepatitis Bvirus HBV) is a contagious disease caused by infection, easily lead to chronic infection, and eventually evolved into liver cirrhosis and hepatocellular carcinoma. There are about 400 million people with chronic HBV carriers worldwide, nearly 30% of the world's population is infected have been infected with HBV.2006 or hepatitis B national epidemiological survey shows that China's general population aged 1~59 of hepatitis B virus carrying rate was 7.18%, 0.96% children under the age of 5, the existing chronic HBV infection about 93 million people, of which about 20 million of patients with chronic hepatitis B. Early detection of the severity of liver damage in patients with viral hepatitis is very important, at present a lot of detection the liver function index, but it is difficult to accurately and objectively reflect the functional status of the liver. Alpha 1 microglobulin (alpha 1-microglobulin, alpha 1-MG) for a relatively small molecule glycoprotein molecular mass of 26 000~33 000, Widely distributed in the body, mainly by the liver cell specific synthesis, transportation and distribution of blood into the body with a variety of organizations, plays an important physiological role. Objective: in this paper, by measuring the level of serum of 243 cases of patients with CHB. 1-MG, and compared with other commonly used indicators of liver function, and to evaluate its clinical significance in detection of CHB patients the. Methods: 243 cases of CHB patients were divided into normal group, liver and kidney function, normal liver function abnormal renal function group, normal group and liver function abnormal renal function abnormal liver function group, and 67 healthy persons were selected as control group, serum alpha 1-MG levels measured for each group of subjects, the simultaneous determination of alanine aminotransferase transferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and other indexes of liver function and serum creatinine (CREA), urea nitrogen (BUN) and other indexes of renal function. Alpha 1-MG was detected by immune turbidimetry, ALT UV - lactic acid dehydration Hydrogen enzyme method, AST UV - malate dehydrogenase, ALP using AMP buffer method, CREA using sarcosine oxidase method, BUN UV - glutamic acid dehydrogenase method. Results: compared with the control group, abnormal renal function in patients with normal liver function group. Serum 1-MG levels were significantly lower (P0.05), liver and kidney the function of normal and abnormal function of the liver and kidney. The serum 1-MG level in patients with no significant change (P0.05), normal renal function in patients with abnormal liver function group. Serum 1-MG levels were significantly increased (P0.01). According to the 1-MG10 mg alpha L-1 for judging the abnormal liver function, abnormal liver function in normal renal function group in serum of patients with 1-MG positive. The rate is 36%, liver and kidney dysfunction group positive rate of serum alpha 1-MG 24%; alpha 1-MG15 mg, such as L-1 standard, then the abnormal renal function normal liver function group positive rate of serum alpha 1-MG abnormal renal function of 68%. patients with normal liver function serum alpha 1-MG water Flat and ALT of liver function index, a negative correlation between AST and ALP (r=-0.934, r=-0.916, r=-0.847, P0.01), and its value with the severity of liver injury decreased. Conclusion: normal liver and kidney function in patients with CHB serum alpha 1-MG level is slightly lower than the normal control group, but no significant difference with the control group; normal kidney the function of the abnormal liver function group. Serum levels of 1-MG were higher than the normal control group, the impairment of renal function serum alpha 1-MG increased; the abnormal liver function, serum CHB level in patients with 1-MG. According to whether the abnormal renal function and different. If combined with abnormal renal function, while the level of 1-MG. Compared with the control group have no significant difference; such as normal renal function, then investigate the level of 1-MG decreased significantly; alpha 1-MG was negatively correlated with ALT and AST. 1-MG15. Mg to L-1 for judging the abnormal liver function standard, the positive rate of abnormal liver function in simple 68%, alpha 1-MG is detected the liver function in patients with CHB An effective index, but the clinical application to exclude renal dysfunction caused by the interference of.HBV DNA low load group and HBV DNA high level of 1-MG group. No significant difference between 1-MG and alpha level of hepatitis B virus infection seems to have no direct relationship.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

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