血清总胆红素、甘氨胆酸、甲胎蛋白、糖类抗原19-9与胆汁淤滞相关性评价

A meaningful appraisal of cholestasis in serum total bilirubin, cholyglycine, alphafetoprotein and carbohydrate antigen 19-9

目的通过联合检测血清总胆红素(TB)、甘氨胆酸(CG)、甲胎蛋白(AFP)、糖类抗原19-9 (CA19-9)在病程中的浓度变化,评价其在肝内胆汁淤滞病理转归过程中的临床意义。方法分别对96 例慢性病毒性肝炎、26例肝硬化(按肝内胆汁淤滞情况分组)及14例肝癌、50例正常对照的血清样本采用生化方法检测TB,放免法测定CG,电化学发光法测定AFP、CA19-9。结果血清TB在无肝内胆汁淤滞组与对照组及胆汁淤滞无体征组间无显著差异;对照组与胆汁淤滞无体征组间存在显著性差异;胆汁淤滞有体征组、肝硬化组与无肝内胆汁淤滞组、对照组及胆汁淤滞无体征组存在显著性差异 (P<0．01)。肝内胆汁淤滞各组血清CG较无肝内胆汁淤滞组及对照组均显示出显著的差异(P<0．01), 无肝内胆汁淤滞组与对照组间也显示出显著性差异(P<0．01);肝内胆汁淤滞各组CA19-9与无肝内胆汁淤滞肝组存在显著性差异(P<0．01);肝癌组AFP、CA19-9也明显高于各组(P<0_01)。结论临床上胆红素是反映胆汁淤滞的粗略指标,对不同状况的胆汁淤滞判断分型困难;在早期发生肝内胆汁淤滞时CG就表现出显著升高,提示肝内胆汁淤滞,CG与肝脏损伤具有很好的相关性,是较为敏感的肝功指标;AFP反映了肝细胞的坏死再生情况,对胆汁淤滞严重程度有警示意义;CA19-9是胆道肿瘤标志物,初步观察发现其增高与淤滞程度具有相关性。

Objective Appraise the clinical signification how the serum total bilirubin （TB）. cholylglycine （ CG ）, α-fetoprotein （ AFP ）, carbohydrate antigen 19-9 （ CA 19-9 ） have their eoneentration changes in the pathological changes of intrahepatic cholestasis through a eombined detection to them. Methods The serum samples from 96 cases of chronic virus hepatitis, 26 eases of liver （：irrhosis and 50 cases of normal people were detected by biochemistry for TR, by radioimmunoassay for CG, by eletrochemiluminescence for AFP and CA19-9. Results There is no obvious deference of serum TB in the group without intrahepatic eholestasis, the group of eholestasis without clinical symptoms and the control group. There is also a marked deference （P〈0.01） in the group of cholestasis with clinical symptoms, the group of liver cirrhosis, the group without intrahepatic cholestasis, the control group and the group of eholestasis without clinical symptoms. The serum GG from the groups of intraheqatic cholestasis, the group without intrahepatie ebolestasis, and the control group all show a very obvious deference （P〈0.01）. The serum CA19-9 from the groups of intrahepatie eholestasis and the group without intrahepatic eholestasis show an obvious deference. The serum AFP. CA19-9 from the group of liver cancer show a very obvious deference （P〈0.0）. Conclusions In clinc bilirubin is a rough index to reflect eholestasis. It has its own limit in deciding patterns of deferent bile obstrtlction. In the early stage of intrahepatie eholestasis, that the index of CG is high obviously points out exislence of intrahepatie eholestasis, CG and the liver impairment are well interrelated and they are comparatively sensitive indexes of liver function. AFP reflects the regeneration of the liver cell necrosis and it means alarm to the seriousness of intrahepatic cholestasis. CA19-9 is a marker of tumor of bilialy tract. The index increase through an initial observation is interrelated to the seriousness of intrahepatic cholestasis.