急性肝炎、肝硬化和肝癌病人TM检测及其意义

CLINICAL SIGNIFICANCE OF PLASMA THROMBOMODULIN MEASUREMENT IN PATIENTS WITH ACUTE HEPATITIS,HEPATIC CIRRHOSIS AND LIVER CANCER

目的 探讨急性肝炎、肝硬化和肝癌病人血浆血栓调节蛋白（TM）水平及其在疾病病情进展及预后判断中的意义。方法 采用酶联免疫吸附测定（ELISA）方法,检测59例急性肝炎和肝硬化病人（其中急性甲型肝炎20例,急性重症肝炎14例,肝硬化代偿15例,肝硬化失代偿10例）、28例肝癌病人治疗前和治疗后血浆TM水平,并与12例健康者进行对照。结果 急性重症肝炎、肝硬化代偿、肝硬化失代偿组血浆TM水平皆较正常对照组显著增高,急性重症肝炎组明显高于急性甲型肝炎组,肝硬化失代偿组显著高于代偿组（F=389.19,q=3.08～45.77,P〈0.001）;肝癌病人术前血浆TM水平明显升高,与正常对照组比较差异有显著性（F=55.64,q=6.959～17.544,P〈0.05）,Ⅰ、Ⅱ期病人术后10 d的血浆TM水平较术前明显降低,接近正常水平（t′=2.366,t=8.372,P〈0.01）。肝癌病人血浆TM水平随分期的增高而增高,差异均有显著性（F=55.64,q=4.099～17.544,P〈0.05）。结论 TM为血管内皮细胞损伤的标志物,可作为某些肝脏疾病病情进展及预后判断的重要指标。

Objective To study the levels of plasma thrombomodulin （TM）, and to explore its significance in the development and prognosis of in patients with acute hepatitis, hepatic cirrhosis and liver cancer. Methods 59 patients with hepatitis and hepatic cirrhosis, 28 eases of liver cancers were selected into the study, the plasma TM levels were measured by ELISA, of which 19 patients of liver cancer in stage Ⅰ and Ⅱ were measured by the same method before and after operation, respectively, Results Except acute hepatitis, plasma TM levels increased markedly in the group of hepatitis and hepatic cirrhosis, the level of acute fatal hepatitis and decompensated hepatic cirrhosis were higher than those in acute hepatitis and compensated hepatic cirrhosis respectively （F=389.19, P〈0. 001 ）. Compared with normal control group, the preoperative plasma TM level of patients with liver cancer increased obviously （F=55.64,q=6.959-17, 544,P〈0.05）, 10 days after operation, TM levels of plasma TM decreased to normal range in stage Ⅰ and Ⅱ （t′=2.366,t=8.372,P〈0.01）. There were obvious differences of TM between the three stages of preoperative liver cancer, TM level increased upgrading （F=55.64,P〈0.01）, Conclusion As a marker of vascular endothelium cells damaged, the plasma TM levels can be used as an important indicator of the development and prognosis of some liver diseases.