重症肝炎患者同型半胱氨酸水平观察

Serum homocysteine levels in fulminant hepatitis patients

目的探讨同型半胱氨酸(Hcy)与重症肝炎的关系。方法用全自动生化分析仪测定35例重症肝炎患者血清 Hcy 水平,同时检测血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)、门冬氨酸转氨酶(AST)、线粒体型门冬氨酸转氨酶(m-AST)、胆碱酯酶(CHE)、前白蛋白(PALB)、葡萄糖(GLU)、胆固醇(CHO)、肌酐(CREA)活性与含量,观察 Hcy 变化及与各生化指标变化的相关性。结果重症肝炎患者血清 Hcy 水平明显升高[(24.0±5.4)μmol/L],与正常对照[(7.8±3.0)μmol/L]相比差异有统计学意义(t=14.603,P<0.01),异常检出率100%。重症肝炎糖脂降低组 Hcy 水平[(24.6±4.2)μmol/L]比糖脂正常组[(17.4±1.9)μmol/L]明显增高(t=5.414 3,P<0.01)。其变化与TBIL、AST、m-AST 正相关(r=0.4502,0.3980,0.4453),与 CHE、PALB、CHO、GLU 负相关(r=-0.1545,-0.2946,-0.1053,-0.2260),尤其与 TBIL、m-AST 有显著相关性(P<0.05),与ALT 无明显相关性(r=0.0925,P>0.05)。结论高 Hcy 血症可能是重症肝炎的一个危险因素,且与重症肝炎互为因果关系。Hcy 可作为重症肝炎诊断和病情检测的新的生化指标。

Objective To investigate the relationship between serum homocysteine （Hcy） levels and fulminant hepatitis. Methods Serum homocysteine levels in 22 fulminant hepatitis patients were measured and compared with that in controls. Serum TBIL, ALT, AST, m-AST, CHE, PALB, GLU, CHO and CREA in the patients and controls were also measured and their correlations with homocysteine were analyzed. Results Hcy levels in fulminant hepatitis patients [ （ 24. 0 ± 5.4 ） μmol/L ] were significantly higher than that in controls [ （7. 8 ± 3.0） p.mol/L] （ t = 14. 603, P 〈 0. 01 ）. All the patients showed significantly higher Hcy than the controls. Serum Hcy levels in patients with decreased serum glucose and cholesterol [ （24. 6 ±4. 2） μmol/L] were higher than that in patients with ordinary glucose and cholesterol levels [ （ 17.4 ± 1.9 ） μmol/L] （ t = 5.414 3, P 〈 0. 01 ）. Serum Hcy levels were negatively correlated with CHE,PALB,GLU and CHO （r = -0. 154, -0. 294, -0. 105 and -0. 226 ） and positively with TBIL, AST and m-AST （ r = 0. 450, 0. 398 and 0. 445）. Conclusion Increased serum Hcy may be an indicator of fulminant hepatitis and the detection of serum Hcy may be of usefulness in the diagnosis and monitoring of the disease.