乙型肝炎病人血清氨基酸谱变化的临床研究

Clinic research of serum amino acids change in patients with HBV infection

目的探讨乙型肝炎病人血清氨基酸谱变化及其临床意义。方法对105例乙型肝炎血清氨基酸谱进行检测和分析，并与肝功能进行相关性分析。结果急性肝炎病人有8种氨基酸升高，2种降低（P〈0．05），BCAA和AAA均升高，但BCAA／AAA比值降低（P〈0．05）；慢性肝炎有3种氨基酸升高，2种降低（P〈0．05），AAA显著升高（P〈0．01），BCAA／AAA比值下降（P〈0．01）；肝炎肝硬化有3种氨基酸升高，3种降低，缬氨酸降低最显著（P〈0．001），BCAA和BCAA／AAA比值均下降（P〈0．01），AAA升高（P〈0．01）；亚急性重型肝炎有4种氨基酸升高，苏、酪氨酸升高最显著（P〈0．001），3种降低，BCAA和BCAA／AAA比值下降（P〈0．01），AAA升高（P〈0．01）；慢性重性肝炎有4种氨基酸升高，酪氨酸升高最显著（P〈0．001），2种降低（P〈0．05），BCAA下降（P〈0．05），AAA升高（P〈0．01），BCAA／AAA比值在所有组中下降最显著（P〈0．01）。氨基酸谱与肝功能相关性分析显示，BCAA和BCAA／AAA与前白蛋白、白蛋白和CHE成正相关（P〈0．01，P〈0．001），与TBiL、PT呈负相关（P〈0．01）。AAA与TBiL、PT呈显著正相关（P〈0．001），与前白蛋白、白蛋白、CHE成负相关（P〈0．05，P〈0．001）。血氨与BCAA／AAA呈负相关（P〈0．05）。结论乙型肝炎病人血清氨基酸谱发生改变，不同程度的肝损害其变化也不相同。BCAA、BCAA／AAA比值与肝功能密切相关，可间接反映肝细胞炎症及坏死程度。

Objective To investigate hepatitis B serum amino acids change, and its clinical meaning. Methods Examination and analysis 105 hepatitis B patients serum amino acids patterns, and analysis main sign of the liver function relativity. Results Acute hepatitis 8 kinds of amino acids increased, 2 kinds of decreased （P〈0.05）. BCAA and AAA all increased, but BCAA/AAA ratio decreased （P〈0.05）. Chronic hepatitis 3 kinds of amino acids increased, 2 kinds of decreased （P〈0.05）. AAA increased most （P〈0.01）, BCAA/AAA decreased most （P〈0.01）. The hepatitis cirrhosis 3 kinds of amino acids increased, 3 kinds of decreased, VAL decreased most （P〈0.001）; BCAA and BCAA/AAA ratio decreased （P〈0.01）, the AAA increased （P〈0.01）. Subacute severe hepatitis 4 kinds of amino acids increased, THY and TYR increased most （P〈0.001）, 3 kinds of decreased; BCAA and BCAA/AAA ratio decreased （P〈0.01）, AAA increased （P〈0.01）. Chronic severe hepatitis 4 kinds of amino acids increased, TYR increased most （P〈0.001）, 2 kinds of decreased （P〈0.05）; BCAA decreased （P〈0.05）, AAA increased （P〈0.01）, BCAA/AAA ratio decreased most in all sets （P〈0.01）. The amino acids patterns and the liver function relativity analysis manifestation, BCAA and BCAA/AAA become with prealbumin, albumin and CHE become with positive related （P〈0.01）, become with TBiL and PT negative related （P〈0.01）. AAA become with TBiL and PT positive related most （P〈0.001）, become with prealbumin, albumin and CHE positive related （P〈0.05, P〈0.001）. Blood ammonia become with BCAA/AAAs negative related （P〈0.05）. Condusion Hepatitis B patients the pattern of serum amino acids change, which varies with live injure levels. Changes of BCAA, BCAA/AAA ratio with the lever of liver inflammation or necrosis and the indexes of liver biochemistry.