肥胖症儿童肝纤维化指标与血清GPDA活性变化的研究

Research of hepatic fibrosis indicators and serum glycylproline dipeptidyl aminopeptidase activity changes in obese children

目的探讨肥胖症儿童肝纤维化指标透明质酸(HA)、层粘连蛋白(LN)、血清Ⅲ型前胶原肽(PCⅢ)、Ⅳ型胶原(CⅣ)与血清甘氨酰脯氨酸二肽氨基肽酶(GPDA)活性的变化及其在临床上的应用价值。方法对2015年6月至2016年2月在丽水市妇幼保健院儿科门诊诊断为肥胖症的159例6~15岁肥胖症儿童(肥胖症组)和42例9~14岁正常健康儿童(正常对照组)进行肝纤维化指标与血清GPDA活性的比较,并对结果进行分析。结果与正常对照组相比,肥胖症组HA、PCⅢ水平均明显升高(t值分别为7.403、5.405,均P<0.05),以PCⅢ升高明显;肥胖症组GPDA活性差异有统计学意义(t=8.965,P<0.01)。肥胖症患儿治疗前后GPDA活性、HA及PCⅢ指标比较,各检测项目均出现降低,差异均有统计学意义(t值分别为6.452、5.684、4.369,均P<0.05)。PCⅢ与GPDA呈正相关(r=0.602,P<0.05)。结论肥胖症儿童GPDA活性与PCⅢ水平的改变是其肝脏病变的早期敏感指标,两者的动态监测,对于诊断、疗效观察有一定的临床意义。

Objective To discuss the changes of hepatic fibrosis indicators such as hyaluronic acid（ HA）,laminin（ LN）,serum procollagen peptide Ⅲ（ PCⅢ）,collagen Ⅳ（ CIV） and serum glycylproline dipeptidyl aminopeptidase（ GPDA） activity in obese children and their clinical application value. Methods Hepatic fibrosis indicators and serum GPDA activity were compared between 159 patients of6 to 15 years old diagnosed as obesity in pediatric outpatient department of Lishui Maternal and Child Health Care Hospital from June 2015 to February 2016（ obese group） and 42 healthy children of 9 to 14 years old（ control group）. Results were compared between two groups.Results Compared to the control group,HA and PCIII levels in the obese group increased significantly（ t value was 7. 403 and 5. 405,respectively,both P〈0. 05）,especially the increase of PC Ⅲ. The difference in GPDA activity between two groups had significant difference（ t = 8. 965,P〈0. 01）. Comparison to GPDA activity,HA and PCⅢ levels in obese children before treatment,they decreased after treatment and the differences were statistically significant（ t value was 6. 452,5. 684 and 4. 369,respectively,all P〈0. 05）. PCⅢshowed a positive correlation with GPDA（ r = 0. 602,P〈0. 05）. Conclusion Changes of GPDA activity and PCⅢ level in obese children are sensitive indicators of liver lesions at early stage. Dynamic monitoring of both indicators has clinical significance for diagnosis and clinical efficacy observation.