慢性乙型肝炎患者血清α1微球蛋白检测的临床意义

Clinical significance of detection of alpha 1-microglobulin in serum of patients with chronic hepatitis B

目的:检测不同肝功能损伤情况下慢性乙型肝炎(CHB)患者血清α1微球蛋白(α1-MG)的水平,探讨采用α1-MG评价CHB患者肝功能的临床意义。方法:243例CHB患者分为肝肾功能正常组(n=94)、肝功能正常肾功能异常组(n=20)、肝功能异常肾功能正常组(n=100)和肝肾功能异常组(n=29),同时选取健康体检者67人作为对照组,测定各组受试者血清α1-MG水平,同时测定谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和碱性磷酸酶(ALP)等肝功能指标及血清肌酐(CREA)、尿素氮(BUN)等肾功能指标。采用免疫比浊法检测α1-MG水平,采用紫外-乳酸脱氢酶法检测ALT水平,采用紫外-苹果酸脱氢酶法检测AST水平,采用AMP缓冲液法检测ALP水平,采用肌氨酸氧化酶法检测CREA水平,采用紫外-谷氨酸脱氢酶法检测BUN水平。结果:与对照组比较,肝功能异常肾功能正常组患者血清α1-MG水平明显降低(P<0.05),肝肾功能正常组和肝肾功能异常组患者血清α1-MG水平无明显变化(P>0.05),肝功能正常肾功能异常组患者血清α1-MG水平明显升高(P<0.01)。按照α1-MG<10mg·L^(-1)为判断肝功能异常的标准,肝功能异常肾功能正常组患者血清ɑ1-MG阳性率为36%,肝肾功能异常组患者血清α1-MG阳性率为24%;如以α1-MG<15mg·L^(-1)为标准,则肝功能异常肾功能正常组患者血清α1-MG阳性率为68%。肝功能异常肾功能正常组患者血清α1-MG水平与肝功能指标ALT、AST和ALP呈负相关关系(r=-0.934,r=-0.916,r=-0.847,P<0.01),且其数值随着肝损伤程度的加重而降低。结论:α1-MG检测在判断CHB患者肝功能方面具有一定的临床意义,但须排除肾功能损害引起的结果干扰。

Objective： To explore clinical significance of alpha 1 microglobulin （α1-MG） in the evaluation on liver function in the patients with chronic hepatitis B （CHB） through detecting the serum levels of α1-MG in the CHB patients with different liver function injuries.Methods： Total 243 CHB patients were divided into normal liver and renal function group（n=94）,normal liver function and abnormal renal function group（n=20）,abnormal liver function and normal renal function group（n=100）,abnormal liver and renal function group（n=29）,while 67 cases of healthy persons were selected as control group.The serum α1-MG levels of the subjects in various groups were measured by immune turbidimetry; the liver function indexes such as alanine aminotransferase （ALT）,aspartate transaminase （AST）, alkaline phosphatase （ALP）,and the renal function indexes such as creatinine （CREA）,blood urea nitrogen （BUN） were determinedby ultraviolet lactate dehydrogenase method,UV-malate dehydrogenase method,AMP buffer method,sarcosine oxidase method, and UV-glutamic acid dehydrogenase method.Results： Compared with control group,the level of α1-MG in serum of the patients in abnormal liver function and nomal renal function group was significantly decreased （P〈0.05）,the serum α1-MG levels of the patients in normal liver function and renal function group and abnormal liver and renal function group had no significant changes （P〉0.05）,and the serum α1-MG level of the patients in normal liver function and abnormal renal function group was significantly increased （P〈0.01）.According to α1-MG 〈10 mg·L-1 as the standard for judging abnormal liver function,the positive rate of α1-MG in the patients in abnormal liver function and normal renal function group was 36% and the positive rate in abnormal liver and renal function group was 24%.As to α1-MG 〈15 mg·L-1 as the standard,the positive rate of α1-MG in abnormal liver function and normal renal function group was 68%.The serum α1-MG level had negatively correlated with the ALT,AST and ALP of the patients in abnormal liver function and nomal renal function group （r=-0.934,r=-0.916,r=-0.847,P〈0.01）,and its values were decreased with the severity of liver injury.Conclusion： α1-MG detection has certain clinical significance in judging liver function in the patients with CHB,but it is necessary to exclude the interference caused by renal damage.