肝脏疾病患者PTM和EPCR水平的检测及其临床意义

Detection and clinical study of plasma thrombomodulin and the endothelial cell protein C receptor in patients with hepatic disease

目的探讨血浆凝血酶调节蛋白(PTM)和血管内皮细胞蛋白C受体(EPCR)在肝脏疾病患者病变过程中的表达变化及其临床意义。方法应用酶联免疫吸附试验(ELISA)检测慢性乙型肝炎患者56例、肝硬化患者43例、原发性肝癌患者28例和正常对照组30例的PTM和EPCR水平。结果慢性乙型肝炎轻度组PTM和EPCR水平有升高趋势,但与正常对照组比较,差异无统计学意义(t分别=1.09、1.17,P均>0.05),而中重度组均明显高于轻度组和正常对照组,差异均有统计学意义(t分别=4.81、2.61、4.27、3.14,P均<0.05)。肝硬化代偿期组、失代偿期组和原发性肝癌组PTM和EPCR水平均明显高于正常对照组,差异有统计学意义(t分别=5.74、5.35、15.11、8.67、5.07、5.55,P均<0.05),其中失代偿期明显高于代偿期,差异均有统计学意义(t分别=7.78、3.02,P均<0.05)。结论PTM和EPCR与肝脏疾病的病变过程密切相关,联合动态检测PTM和EPCR水平可作为肝脏疾病血管内皮细胞损伤和疾病严重程度的重要观察指标。

Objective To investigate dynamic plasma levels of plasma thrombomodulin （PTM） and the endothelial cell protein C receptor （EPCR） in patients with hepatic disease, and discuss the expression change during the process of hepatic disease and its clinical meanings. Methods Plasma levels of PTM and EPCR were measured respectively using ELISA in 56 patients with chronic type B hepatitis, 43 patients with hepatic cirrhosis, 28 patients with hepatocellutar carcinoma, and 30 normal controls. Results The plasma levels of PTM and EPCR of chronic type B hepatitis in mild period were tending to increase. However, there was no statistical significance between mild and control group （t=-1.09, 1.17, P〉0.05）. While those levels in moderate and severe period were significantly higher than those in mild and control group （t=-4.81, 2.61, 4.27, 3.14, P〈0.05）. Among compensation and decompensation period of hepatic cirrhosis group and primary hepatic cancer group, the plasma levels of PTM and EPCR were all markedly increased, compared with those in the control group. The differences were statistically significant （t=-5.74, 5.35, 15.11, 8.67, 5.07, 5.55, P〈0.05）. In addition, the levels in the decompensation period of hepatic cirrhosis were significantly higher than those in compensation period （t=7.78, 3.02, P〈0.05）. Conclusions PTM and EPCR played important roles in the process of hepatic disease and the dynamic plasma levels of PTM combined with EPCR can be an important index for injure of vascular endothelial cells and severity of hepatic disease.