氨甲酰磷酸合成酶-I和鸟氨酸氨基甲酰转移酶与肝性脑病的关系

The relationship of CPS-I, OCT and hepatic encephalopathy

目的 探讨血清氨甲酰磷酸合成酶Ⅰ（CPS-Ⅰ）和鸟氨酸氨基甲酰转移酶（OCT）在肝性脑病（HE）发生中的作用.方法 2008年1月-2009年12月在我院住院的120例肝硬化患者,其中HE患者25例,非肝性脑病（非HE）患者95例.对照组为我院健康体检正常者60例.收集研究对象的血清和血浆,采用酶联免疫吸附试验方法测定血清CPS-Ⅰ、OCT,VITROS-250干化学分析仪测定血氨.分析HE组、非HE组、对照组CPS-Ⅰ和OCT水平;分析肝硬化患者CPS-Ⅰ、OCT与肝功能及血氨的相关性;分析CPS-Ⅰ、OCT水平与肝硬化患者Child-Pugh分级之间的相关性.应用SPSS15.0软件进行数据分析,采用x2和t检验,计量资料两组间比较采用成组t检验,多组间的比较采用方差分析、q检验,两变量相关分析采用Pearson相关分析法.结果 HE组血清CPS-Ⅰ、OCT水平分别为（143.3±48.5）U/L和（297.0±102.6）×10 U/L,非HE组分别为（180.3±51.5）U/L和（351.8±109.0）×10 U/L,t值分别为2.53和2.78,P值均＜0.01;HE组、非HE组血清CPS-Ⅰ、OCT水平均低于正常对照组,t值分别为3.21、4.16和2.12、3.15,P值均＜0.05.CPS-Ⅰ与OCT相关性好,r=0.946,P＜0.05;CPS-Ⅰ、OCT与ALT、AST呈负相关,r值分别为-0.284、-0.239、-0.303、-0.322,P值均＜0.05.肝硬化患者CPS-Ⅰ、OCT水平和Child分级密切相关,F值分别为10.13,20.28,P值均＜0.01.结论 肝硬化患者CPS-Ⅰ和OCT活性影响血氨水平,CPS-Ⅰ和OCT与肝性脑病的发生密切相关.

Objective To study the role of carbamyl phosphate Ⅰ （CPS-Ⅰ）and ornithine transcarbamoylase （OCT） levels in cirrhosis patients with and without hepatic encephalopathy, and to analyze the correlations between CPS-Ⅰ and OCT with the development of hepatic encephalopathy. Methods CPS-Ⅰ,OCT, plasma ammonia and liver function of 95 cirrhosis patients with hepatic encephalopathy and 25 cirrhosis patients without hepatic encephalopathy in our hospital from January 2008 to December 2009 were analyzed.60 healthy controls were recruited in the control group. The differences of serum CPS-Ⅰ, OCT levels among the cirrhosis patients with and without hepatic encephalopathy and the healthy controls were analyzed; the correlations of CPS-Ⅰ, OCT levels with plasma ammonia and total protein in cirrhosis patients,and the correlations of CPS-Ⅰ, OCT levels with Child-Pugh classification of cirrhosis symptom severity in cirrhosis were analyzed. the clinical characteristics between patients who had HE and no HE with chi-square tests were compared. Comparisons of CPS-Ⅰ, OCT levels across patients based on the Child-Pugh classification were performed with One-Way ANOVA and Student-Newman-Keuls, correlation of CPS-Ⅰ, OCT with other indicators were performed with Pearson correlation analysis. Results Serum CPS-Ⅰ and OCT levels in cirrhosis patients with hepatic encephalopathy were （143.3 ± 48.5） U/L, （297.0 ± 102.6） × 10 U/L, which were lower than that in cirrhosis patients without hepatic encephalopathy （180.3 ± 51.5） U/L, （351.8 ± 109.0） ×10 U/L （t = 2.53, t = 2.78, P less than 0.01）. Compared with healthy controls, serum CPS-Ⅰ and OCT levels in cirrhosis patients with and without hepatic encephalopathy were all lower （t = 3.21, t = 4.16, t = 2.12, t = 3.15,P less than 0.05）. CPS-Ⅰ was correlated with OCT, （r = 0.946, P less than 0.05）; CPS-Ⅰ and OCT were negatively correlated with ALT and AST （r = -0.284, r = -0.239, r = -0.303, r = -0.322, P less than 0.05）.Additionally, CPS-Ⅰ and OCT levels were negatively correlated with the Child-Pugh classification in Cirrhosis （F = 10.13, F = 20.28, P less than 0.01）. Conclusion The serum CPS-Ⅰ and COT levels were important factors affecting plasma ammonia in patients with cirrhosis and played an important role in the development of hepatic encephalopathy.