血浆总胆汁酸水平与乙肝肝硬化合并胆囊结石成因的关系

Relationship between plasma total bile acid levels and hepatitis B cirrhosis combined with gallstones formation

目的分析乙肝肝硬化合并胆囊结石患者血清学指标，探讨其与胆囊结石形成的相关性。方法收集2008年9月至2010年9月收治的患者资料，分为乙肝肝硬化合并胆囊结石组（甲组）、非胆囊结石组（乙组）、单纯胆囊结石组（丙组）、对照组（丁组），分析其血清学指标是否存在差异，其中乙肝肝硬化合并胆囊结石组中按肝功能Child-Pugh分级分为ChildA、ChildB、ChildC三组，分析不同肝功能Child—Pugh分级下血清学指标[总胆汁酸（TBA）、总胆红素（TBiL）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）、白蛋白（ALB）、凝血酶原时间（PT）、5’-核苷酸酶（5＇-NT）、Q—L岩藻糖苷酶（AFU）]变化趋势，为临床防治乙肝肝硬化胆囊结石形成提供新依据。结果甲组TBA高于乙、丙、丁组，ALB低于乙、丙、丁组，差异均有统计学意义（P〈0．05）；乙组、丙组TBA高于丁组，ALB低于丁组，差异有统计学意义（P〈0．05）；乙组与丙组之间各项血清学指标比较差异均未见统计学意义。乙肝肝硬化合并胆囊结石患者血清TBA与肝功能Child—Pugh分级呈正相关，血清ALB水平与肝硬化Child—Pugh分级呈负相关，血清TBiL、GGT、ALP、5’-NT、PT、AFU与分级之间无显著相关性。结论乙肝肝硬化患者胆囊结石形成与高血浆总胆汁酸有密切关系，并且与肝功能损害程度有关。

Objective To analyze the serum indexes of patients with hepatitis B cirrhosis combined with gallstones and investigate the relationship between the serum indexes and the formation of gallstone. Methods From September 2008 to September 2010, the clinical data of patients in our hospital were collected, the patients were divided into hepatitis B cir- rhosis combined gallstones group （group A）, the gallbladder stone group （group B）, simple gallbladder stone group （group C） and the control group （group D）, and the serum indexes were analyzed. In addition, according to liver function child, group of hepatitis B cirrhosis combined with gallstones was subdivided into three groups （ Child-Pugh class A, Child-Pugh class B, Child-Pugh class C）, and the serum indexes（ total bilirubin TBiL, total bile acid TBA, alanine aminotransferase ALT, aspertate aminotransferase AST, alkaline phosphatase ALP, gamma glutamyl transpeptidase GGT） were analyzed. Results The TBA level of group A was higher than that of group B, group C, group D, and the ALB level was lower than that of group B, group C, group D, there were significant differences. The TBA level of group B and group C was higher than that of group D, and the ALB level was lower than that of group D, there were significant differences. The serum indexes between group B and group C had no significant difference. In the group of hepatitis B cirrhosis combined with gall- stones, serum TBA was positively correlated with Child-Pugh grade, and serum ALB was negatively correlated with Child- Pugh grade. The levels of serum TBiL,GGT,ALP,5 - NT,PT,AFU and PT all had no significant correlation with Child- Pugh grade. Conclusions The formation of gallbladder stone in Hepatitis B cirrhosis is closely correlated with high serum total bile acid, and which is correlated with liver damage.