肝硬变时细胞外基质代谢的血清学研究

Serologic study on extracellular matrix metabolism in patients with viral liver cirrhosis

目的研究肝纤维化时细胞外基质代谢的血清学变化规律，以及抗肝纤维化治疗的重要性．方法实验对象２６９例分为３个观察组，即正常对照组（ｎ＝３０）ＣｈｉｌｄＡ组（ｎ＝１０３）及ＣｈｉｌｄＢ＋Ｃ组（ｎ＝１６６）．对每例观察对象作血清透明质酸（ＨＡ），Ⅲ型前胶原肽（ＰⅢＰ），Ⅳ型前胶原肽（ＰⅣＰ）．层粘蛋白（ＬＮ）水平测定和肝功能有关指标，如ＡＳＴ，ＡＬＴ，甘胆酸（ＣＧ）和吲哚氰绿（ＩＣＧ）潴留率等检测．结果和正常组比较，ＣｈｉｌｄＡ组及ＣｈｉｌｄＢ＋Ｃ组ＨＡ，ＰⅢＰ，ＰⅣＰ，ＬＮ以及ＡＬＴ，ＡＳＴ，ＣＧ，ＩＣＧ潴留率均值呈异常升高（Ｐ＜００１），但ＣｈｉｌｄＡ组及ＣｈｉｌｄＢ＋Ｃ组间无统计学差异．进一步研究还发现ＰⅢＰ，ＰⅣＰ，ＨＡ以及ＬＮ等血清浓度和ＣＧ，ＩＣＧ潴留率，ＡＳＴ，ＡＬＴ间呈密切正相关，经保肝、利胆等治疗，在血清ＡＳＴ，ＡＬＴ，ＣＧ及ＩＣＧ潴留率好转后ＨＡ，ＰⅢＰ，ＰⅣＰ，ＬＮ的血清水平也呈同向变化．结论部分肝硬变患者，肝纤维化的形成仍很活跃，积极有效的保肝，利胆。

AIM To study the metabolism of extracellular matrix in patients with viral liver cirrhosis and the importance of anti liver fibrosis therapy. METHODS Viral liver cirrhosis patients were divided into two groups according to Child Pugh standard, Child A ( n =103) and Child B+C ( n =166). Serum contents of hyaluronic acid (HA), propeptide of procollagen type Ⅲ (PⅢP), propeptide of procollagen type Ⅳ (PⅣP), laminin (LN), AST, ALT, CG and ICG retention rate (ICG RR) of each person were measured at the same time. Normal subjects ( n =30) were also studied as controls. RESULTS Mean serum content of HA, PⅢP, PⅣP, LN, AST, ALT, CG and ICG RR were all higher in group Child A and group Child B+C than normal controls ( P >0 01). There were no significant differences between group Child A and group Child B+C. Meanwhile serum HA, PⅢP, PⅣP and LN had closely positive correlations with serum AST, ALT, CG and ICG RR, and serum HA, PⅢP, PⅣP and LN decreased when serum ALT, AST, CG and ICG RR recovered after effective treatment. CONCLUSION In some patients with viral liver cirrhosis, fibrogenesis is still progressing, and effective antifibrotic drugs are necessary.