肝组织病理与肝细胞合成功能的关系

Study on relationship between the pathology and the synthetic function indexes of the liver

目的研究肝组织病理损害与血清胆碱酯酶、清蛋白、胆固醇及血浆凝血酶原活动度的关系。方法对135例患者肝组织进行病理分级(G1～G4)、分期(S1～S4),采用酶速率法,测定血清胆碱酯酶、清蛋白及胆固醇;采用比浊法测定血浆凝血酶原活动度。结果在慢性肝炎轻度,胆碱酯酶活力、凝血酶原活动度、清蛋白及胆固醇下降的百分率分别为20.6％,10.3％,0.0％和0.0％,中度下降的百分率分别为39.0％,24.4％,4.9％和0.0％,差异均有非常显著性意义(P均<0.001);随着肝组织炎症程度的加重(G1～G4),胆碱酯酶活力平均值分别为:136.0,111.6,91.0和20.8 μkat·L^(-1)。凝血酶原活动度平均值分别为:1.03,0.90,0.75和0.17,清蛋白平均值分别为44,43,40和28 g·L^1,胆固醇平均值分别为4.4,3.9,4.3和1.5 mmol·L^(-1),差异均有非常显著性意义(P均<0.001);随着肝组织纤维化程度的加重(S1～S4),胆碱酯酶活力平均值分别为:120.3,97.2,86.0和22.1 μkal·L^(-1),凝血酶原活动度平均值分别为:0.92,0.84,0.72和0.23,清蛋白平均值分别为43,41,40和28g·L^(-1),胆固醇平均值分别为4.1,4.5,4.2和1.7 mmol·L^(-1),差异均有非常显著性意义(P均<0.001);它们彼此间相关系数为0.565～0.778(P均<0.001)。结论血清胆碱酯酶活力较凝血酶原活动度、清蛋白及胆固醇能更敏感地反映肝脏的合成功能,能更准确地反映肝脏的病理损害程度,它们均与肝脏的病理损害呈明显的负相关。

AIM To investigate the relationship between the pathology of the liver and serum cholinesterase, albumin, cholesterol and plasma prothrombin activity in viral hepatitis. METHODS A total of 135 patients were diagnosed as chronic hepatitis, liver cirrhosis with or without liver failure using needle biopsy. Serum cholinesterase, albumin and cholesterol were examined by enzyme rate assay; plasma prothrombin activity was tested by turbidimetry. RESULTS The decreased level of cholinesterase, prothrombin activity, albumin, cholesterol in chronic mild hepatitis were 20.6%,10.3%, 0.0% and 0.0%, respectively (P<0.001); that of cholinesterase, prothrombin activity, albumin, cholesterol in chronic modest hepatitis was 39.0%, 24.4%, 4.9% and 0.0%, respectively. In chronic hepatitis grade 1 to grade 4, mean cholinesterase was 136.0, 111.6, 91.0 and 20.8 μkat ·L^(-1),respectively (P<0.001); mean prothrombin activity was 1.03, 0.90, 0.75 and 0.17, (P<0.001); mean albumin was 44, 43, 40 and 28g·L^(-1), (P<0.001); and mean cholesterol was 4.4, 3.9, 4.3 and 1.5 mmol·L^(-1), (P<0.001). In chronic hepatitis stage 1 to stage 4, mean cholinesterese was 120.3, 97.2, 86.0 and 22.1 μkat·L^(-1), (P<0.001); mean prothrombin activity 0.92, 0.84, 0.72 and 0.23, (P<0.001); mean albumin 43, 41, 40 and 28g·L^(-1), (P<0.001), and masn cholesterol 4.1, 4.5, 4.2 nd 1.7mmol·L^(-1), respectively (P<0.001).The correlation coefficient between cholinesterase, prothrombin activity, albumin and cholesterol was 0.565-0.778 (P<0.001). CONCLUSION The level of serum cholinesterase can reflect more sensitively the synthetic function of the liver than that of serum albumin, cholesterol and plasma prothrombin activity. They are all negatively relative with the damage of the pathology of the liver.