慢性乙型肝炎患者血清瘦素水平与肝纤维化程度相关

Serum leptin level and the severity of liver fibrosis in chronic hepatitis B and the effects of Peginterferon Alfa-2a treatment

目的 研究血清瘦素与慢性乙型肝炎肝脏炎症和肝纤维化程度之间的关系。方法 20例慢性乙型肝炎患者在聚乙二醇α-2a干扰素治疗前及治疗48周、随访24周后进行肝穿刺病理学检查，另20例患者进行1次肝穿刺。采用ELISA方法检测加例慢性乙型肝炎患者血清瘦素水平，20名健康人作为对照组，对血清瘦素与肝组织炎症分级、纤维化分期间的关系进行分析。结果 慢性乙型肝炎患者血清瘦素水平（12．89±7．47）ng／ml明显高于健康对照组（2．57±1．29）ng／ml，差异有统计学意义（P〈0．05）。S0（5例）、S1（14例）、S2（16例）、S3（14例）、S4（11例）期肝纤维化血清瘦素水平分别为（2．62±0．89）ng／ml、（5．26±1．60）ng／ml、（13．15±4．52）ng／ml、（17．08±3．78）ng／ml、（21．56±5．89）ng／ml，随纤维化程度加重，血清瘦素水平增加；血清瘦素水平与肝组织纤维化分期成正相关（r=0．845，P〈0．01）。20例患者在聚乙二醇α-2a干扰素治疗前、后肝组织纤维化计分分别为10．91±6．32和7．43±4．15，差异有统计学意义（P〈0．05）；治疗前、后血清瘦素水平分别为18．35±4．93和13．57±5．39，差异有统计学意义（P=0．006）。G0（4例）、G1（12例）、G2（22例）、G3（16例）、G4（6例）级炎症血清瘦素水平分别为（2．66±1．03）ng／ml、（9．04±4．92）ng／ml、（13．22±7．38）ng／ml、（16．19±7．71）ng／ml、（17．41±4．25）ng／ml，G0与G1级、G1与G2级患者血清瘦素水平差异无统计学意义（P=0．006），G2、G3、G4级患者血清瘦素水平差异无统计学意义（P〉0．05），G3～G4级患者血清瘦素水平与G1级相比，差异有统计学意义（P〈0．05）。结论 血清瘦素与慢性乙型肝炎肝组织纤维化分期密切相关。

Objective To evaluate the relationship of serum leptin levels and severity of liver inflammation and fibrosis in patients with chronic hepatitis B. Methods Serum leptin levels were determined in 40 patients with histologically proven chronic hepatitis B and 20 cases of healthy controls by enzyme linked immunosorbent assay. 20 of the 40 patients received 48 weeks of Peginterferon Alfa-2a （40 kD） treatment and liver biopsies were done at the beginning and in 24 weeks of follow-up. The histological response were assessed according to modified Scheuer staging and Chevallier＇ s scoring system. Serum leptin levels in all of the 60 samples were analyzed compared with the liver inflammation grade and fibrosis stage. Results Serum leptin was increased significantly in patients with hepatitis B compared with the healthy controls [ （12.89 ± 7.47） ng/ml vs （2.57 ± 1.29） ng/ml, P 〈 0.01 ）]. In patients with fibrosis staging 0 through 4, leptin levels were （2.62 ± 0.89） ng/ml, （5.26 ± 1.60） ng/ml, （ 13.15 ± 4.52） ng/ml, （ 17.08 ± 3.78） ng/ml and （21.56 ± 5.89） ng/ml, respectively, showing a positive correlation with hepatic fibrosis staging （ r = 0.845, P 〈 0.01）. In 20 patients treated with Peginterferon Alfa-2a, fibrosis score decreased from 10.91 -6.32 to 7.43 ± 4.15（P = 0.047）. serum leptin level decreased significantly from 18.35 - 4.93 to 13.57 ± 5.39 （ P = 0. 006）. In patients with inflammation grading 0 through 4, leptin levels were 2.66 ± 1.030 ng/m1,9.04±4.92 ng/ml, 13.22 ± 7.38 ng/ml, 16.19 ± 7.71 ng/ml, 17.41 ± 4.25 ng/ml. respectively. There was no significant difference in serum leptin between inflammation grade 2 through 4, but leptin levels in grade 3 and 4 were significantly higher than grade 1. Conclusion Serum leptin level is correlated with the severity of liver fibrosis in chronic hepatitis B and decreased after Peginterferon Alfa-2a treatment.