慢性病毒性肝炎患者血清内毒素结合蛋白的临床意义

Study on the level of lipopolysaccharide binding protein in serum of patients with chronic viral hepatitis

目的探讨血清内毒素结合蛋白（LBP）与肝脏炎症程度之间的关系.方法采用酶联 免疫吸附法（ELISA）检测99例慢性病毒性肝炎患者血清中LBP水平,其中33例慢性重型肝炎患者入院后2～4周复查LBP.结果肝炎组LBP值（79.62±45.52）ng/ml高于正常对照组（50.22±31.44）ng/ml（P=0.001）.慢性重型肝炎组血清LBP值明显高于慢性肝炎中、重度及正常人（P＜0.05）.慢性重型肝炎治疗后好转组LBP值明显低于病死组及治疗前LBP值（P＜0.01）,抗菌治疗组LBP值明显低于未抗菌治疗组及治疗前（P＜0.01）.抗菌治疗组好转率64.3%（11/17）明显高于未抗菌治疗组25.0%（4/16）.LBP与血清白蛋白、胆碱酯酶、血红蛋白呈负相关,与血清总胆红素、Ⅲ型前胶原、凝血酶原时间呈正相关.结论慢性肝炎患者血清LBP增高与肝脏损害程度密切相 关,治疗后LBP值下降者预后较好.

Objective To investigate the relationship between lipopolysaccharide binding pro tein（LBP） in serum and degree of hepatic inflammation. Methods The levels of LBP in serum of 99 patients with chronic viral hepatitis （CVH） were detected by ELISA. The levels of LBP in 33 of all patients with chronic severe viral hepatitis were further detected 2-4 weeks after treatment. Results The serum levels of LBP in patients with chronic viral hepatitis were higher than that in normal patients [（79.62 ± 45.52） ng/ml vs （50.22 ± 31.44） ng/ml, P =0. 001]. The serum levels of LBP in patients with chronic severe viral hepatitis were significantly higher than that in patients with moderate degree CVH group, severe degree CVH group, and normal group （P 〈 0. 05）. The serum levels of LBP in improving group after treatment were obviously lower than that in the group before treatment and dead group in patients with chronic severe hepatitis （P 〈 0.01）. The serum levels of LBP were significantly lower in antibiotic treatment group than in non-antibiotic treatment group and the group before antibiotic treatment （P 〈 0.01）. The improving rate in antibiotic treatment group was obviously lower non antibiotic treatment group （64.31 % vs 25.00 %）. The level of LBP was negatively relative to the levels of albumin, cholinesterase, hemoglobin. The level of LBP was positively relative to the levels of serum total bilirubin, type Ⅲ procollage, prothrombin time. Conclusion The increasing levels of LBP in patients with chronic viral hepatitis were tightly relative to the degree of damage on liver cell. The prognosis would be better in the patient with decreasing LBP after treatment.