三氯乙烯药疹样皮炎患者肝血流动力学改变与肝纤维化指标的相关性研究

Correlation between Change of Hemodynamics and Markers of Liver Fibrosis among Patients with Trichloroethylene Medicamentous Dermatitis

目的探讨三氯乙烯药疹样皮炎患者(TCEMD)肝脏血流动力学参数改变与肝纤维化指标的关系,为判断三氯乙烯药疹样皮炎肝损害的程度和预后提供依据。方法选择30例三氯乙烯药疹样皮炎患者作为观察组,30例同时期健康体检者作为对照组,用彩色多普勒超声仪,检测门静脉内径(PVD)、瘀血指教(CI)及血流量(PBF),门静脉血流速度(PBV)、肝静脉内径(HVD);用放射免疫法检测肝纤维化指标透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)、甘胆酸(CG)的水平,并对观察组与对照组的肝血流动力学参数与肝纤维化指标进行相关分析。结果肝纤维化指标HA、PCⅢ、C-Ⅳ和CG观察组高于对照组(P<0.05),肝血流动力学参数PVD及CI观察组高于对照组(P<0.01),与肝纤维化指标水平呈正相关;PBV及HVD观察组低于对照组(P<0.01),与HA、C-Ⅳ水平呈负相关;而PBF观察组和对照组无差别(P>0.05),与PCⅢ呈负相关。结论TCEMD患者肝血流动力学参数与肝纤维化指标有良好的相关性,两者相结合能够较好地反映其肝损害程度,都可作为患者肝损害程度的评价指标,也可作为评价其预后和疗效的无创伤性方法应用于临床。

Objective To analyse the correlation between changes of liver hemodynamics and liver fibrosis markers in patients with trichloroethylene medicamentous dermatitis （TCEMD） and furthermore study the prognosis of these patients with liver disfunction. Methods 30 patients with TCEMD and 30 healthy persons were studied. Portal vein dismeter （PVD）, congestive index （CI）, portal blood flow （PBF）, portal blood velocity （PBV） and hepatic vein diameter（HVD） were measured with Color Doppler System. Serum levels of HA, LN,PC Ⅲ, C-Ⅳ and CG were determined with RIA. The linear relationship between the serum indices of hepatic fiborsis and the indicators of liver hemodynamics was calculated. Results Serum levels of HA, LN, PC III, C-Ⅳ and CG in the patients increased significantly compared with that in the control persons （P 〈 0.01） and there was a positive correlation between liver fibrosis indicator and PVD or CI. PBV and HVD in patients were lower than that in the control （P 〈 0.01） and there was a negative correlation with HA and C-Ⅳ. PBF has no difference between the patient group and control （P 〉 0.05） and there was a negative correlation with PC Ⅲ （P 〈 0.01）. Conclusion There was sensitive correlation between liver hemodynamics and liver fibrosis markers in patients with TCEMD. The change of theses indicators could indicate the degree of liver damage in the patients with TCEMD. These indicators would be useful to predict and assess the prognosis of the patients with TCEMD.