支链氨基酸/芳香氨基酸(BCAA/AAA)值在病毒性肝炎的临床意义

Clinical significance of serum BCAA/AAA value in viral hepatitis

目的探讨BCAA/AAA比值在病毒性肝炎各临床类型中的变化及其相关性,进一步分析其在肝性脑病发生机制中的作用.方法从1999年9月至2001年4月,总结病毒性肝炎患者154例,年龄32～68岁,平均(54.2±21.0)岁.男104例,女50例,男:女为2.1:1.其中急性肝炎22例,慢性肝炎65例,重型肝炎20例,肝硬化47例.按血清病原学检测,甲型11例,乙型106例,丙型1例,戊型8例,重叠感染16例,病原未明12例.肝硬化Child-Pugh分级为A、B及C.BCAA及AAA用液相色谱法测定,BCAA/AAA正常值为3.0～3.8.结果BCAA/AAA比值在急性肝炎基本正常,慢性肝炎轻度低于急性肝炎(P＞0.05);慢性肝炎重度显著低于慢性肝炎中度(P＜0.001);重型肝炎或肝硬化低于慢性肝炎重度(P＜0.05),各组相比,差异有显著性或非常显著性.在Child-Pugh分级中,BCAA/AAA比值C级＜B级＜A级,各组间相比,差异有非常显著性(P＜0.001或P＜0.02).在重型肝炎或肝硬化中,发生肝性脑病组的BCAA/AAA比值显著低于未发生肝性脑病组(P＜0.001);死亡组的BCAA/AAA比值显著低于存活组(P＜0.01或P＜0.005).结论BCAA/AAA值的测定,在一定程度上能反映肝脏受损情况.其比值越低,肝脏受损越严重,且容易出现肝性脑病.该值对于患者的预后判断也有一定的参考价值.

Objective To investigate the significance of serum ratio of BCAA/AAA in viral hepatitis and its relationship with the extent of liver damage. Methods From Sep. 1999 to Apr. 2001, 154 cases of viral hepatitis were included in the study, 104 males and 50 females with average age 54.2 ± 21.0 year. They were acute hepatitis （22 cases）, chronic hepatitis （65 cases）, severe hepatitis （20 cases） and cirrhosis （47 cases）. According to the virology, there were 143 cases of viral hepatitis, and 12 cases with unknown cause. Cirrhosis was classified as A, B, C, according to Child-Pugh classification. BCAA/AAA ratio were measured by high-performance liquid chromatography, the normal range was 3.0 to 3.8. Results BCAA/AAA ratio is normal in acute hepatitis, and was little lower in chronic hepatitis （mild） （P 〉 0.05）. The ratio in severe hepatitis or in cirrhosis was lower than that in chronic hepatitis （P 〈 0.05 ）. With the Child-Pugh classification, the ratio was lowest in class C, and lower in class B than that in class A. In severe hepatitis or cirrhosis, the ratio is lower in HE （Hepatic encephalopathy） group than that without HE （P 〈 0.001）. And the ratio was lower in patients who died than that who survived （P 〈 0.01 or P 〈 0.005）. There was significant statistic difference between each group, respectively. Conclusion The serum ratio of BCAA/AAA reflect the extent of liver damage. The lower the ratio, the severer the extent of liver damage. The ratio might be of prognostic significance for hepatitis.