血清铁和铁蛋白与肝病患者肝纤维化指标的关系

Relationship of serum iron and ferritin with the indicators for hepatic fibrosis

目的研究血清铁和铁蛋白与肝脏疾病患者血清肝纤维化指标(透明质酸、层粘蛋白、人Ⅲ型前胶原、Ⅳ型胶原)的关系。方法采用1s快速肝穿刺法对41例肝病患者取肝组织标本,行HE和铁染色后镜检;同时分别应用原子吸收光谱法、放射免疫法和酶联免疫法检测患者的血清铁、血清铁蛋白、肝纤维化指标。结果良性肝病患者与肝细胞癌患者比较,血清铁测定值无显著性差异(P>0.05),血清铁蛋白差异显著(P<0.05);良性肝病患者、早期肝细胞癌患者肝纤维化指标测定值与正常对照组间有显著性差异(P<0.05),晚期肝癌患者的肝纤维化指标与正常对照组间的差异无统计学意义(P>0.05)。血清铁及血清铁蛋白与层粘蛋白具有统计学上的相关性(血清铁r=0.439,P=0.031;血清铁蛋白r=0.476,P=0.016)。肝癌组织没有发现铁颗粒沉积。结论肝细胞癌患者多出现血清铁蛋白升高;血清铁、血清铁蛋白测定值和层粘蛋白测定值具有相关性;与良性肝病相比,肝癌组织的铁含量明显降低。晚期肝癌患者纤维化指标下降,可能与肿瘤组织抑制了胶原合成有关。酒精性脂肪肝多合并肝铁过载;对于良性肝脏疾病血清铁和铁蛋白测定值可以作为肝铁过载的重要指标。

Objective To study the relationship of serum iron a nd ferritin with the indicators for hepatic fibrosis and hepatic iron overload. M ethods Liver tissue specimens were obtained from 41 patients with benign (16) or malignant (25) liver diseases by 1 second liver biopsy, and routine microscopi c examination was performed after haematoxylin-eosin (HE) and Perl's Prussian s taining. Atomic absorption spectrum, radioimmunoassay and enzyme-linked immunoso rbent assay were respectively employed to examine the serum levels of iron, fer ritin, hyaluronic acid, laminin, human procollagen type Ⅲ, and collagen type Ⅳ. Results Between patients with benign and malignant liver diseases, significa nt differences were found in the serum ferritin levels (P<0.05), but not in ser um iron levels (P>0.05). It was also noted that the levels of the indicators for hepatic fibrosis in patients with benign and early-stage malignant di seases varied significantly from the levels in normal subjects, but thes e differences were not observed between normal subjects and patients with end-st age hepatic malignancies. Serum iron and ferritin were found to be associated w ith serum laminin levels (serum iron: r=0.439, P=0.031; serum ferritin: r=0.476 , P=0.016), and no iron granules detected in the tissue specimens of hepatocellu lar carcinoma. Conclusions Most of the patients with hepatocellular carcino ma have elevated serum ferritin levels. The serum levels of iron and ferritin are statistically correlated with serum laminin level. Obvious reduc tion of iron content is typical of hepatic malignant tissues in comparison with the benign tissues, and the reduction in the levels of the indicators for hepat ic fibrosis might involve the inhibition of collagen synthesis in the tumor tis sues from patients with end-stage hepatocellular carcinoma. Most of the cases o f alcoholic fatty liver are complicated by liver iron overload, often marked by serum iron and ferritin levels.