老年病毒性肝炎病人继发肝硬化危险因素分析

Analysis of the risk factors of secondary cirrhosis in the elderly patients with viral hepatitis

目的探究老年病毒性肝炎继发肝硬化病人血清基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶组织抑制因子(TIMP-1)、血清胱抑素C(Cys-C)以及肝纤维化指标的变化,分析肝硬化的危险因素。方法选择2017~2018年我院和中大医院收治的老年病毒性肝炎病人80例,其中40例继发肝硬化病人为观察组;未继发肝硬化病人40例为对照组。采用ELISA法检测血清MMP-2、TIMP-1、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)和层黏连蛋白(LN)的水平,采用免疫比浊法检测Cys-C水平,比较2组上述指标的差异,并对老年病人病毒性肝炎继发肝硬化相关危险因素进行分析。结果与对照组相比,观察组血清MMP-2、TIMP-1和Cys-C以及肝纤维化相关因子HA、PCⅢ和LN的表达均显著升高(P<0.05);多因素Logistic回归分析显示,进行抗病毒治疗和保肝治疗是病毒性肝炎继发肝硬化的保护性因素(P<0.05),饮酒和晚睡是病毒性肝炎继发肝硬化的独立危险因素(P<0.05)。结论病毒性肝炎继发肝硬化的老年病人血清MMP-2、TIMP-1、Cys-C、HA、PCⅢ和LN水平都显著升高;抗病毒治疗和保肝治疗能有效降低继发肝硬化的风险,而饮酒和晚睡则会加重肝硬化进程,应加强对上述因素的重点干预。

Objective To explore the levels of serum matrix metalloproteinase-2(MMP-2),matrix metalloproteinase inhibitor(TIMP-1),cystatin C(Cys-C),liver fibrosis related indexes and to analyze the risk factors of the elderly patients with viral hepatitis secondary cirrhosis.Methods A total of 80 patients with viral hepatitis were selected from January 2017 to December 2018 in our hospital.Among them,40 patients with secondary cirrhosis were selected as observation group,while the other 40 patients as control group.The levels of serum MMP-2,TIMP-1,hyaluronic acid(HA),procollagen typeⅢ(PCⅢ)and laminin(LN)were detected by enzyme-linked immunosorbent assay(ELISA),and the level of Cys-C was detected by Turbidimetric inhibition immuno assay.The risk factors of the elderly patients with viral hepatitis secondary cirrhosis were analyzed.Results Compared with the control group,the expressions of serum MMP-2,TIMP-1,Cys-C,HA,PCⅢand LN were significantly increased in the observation group(P<0.05).Logistic regression analysis showed that antiviral therapy and liver protection therapy were protective factors for viral hepatitis secondary cirrhosis(P<0.05),while drinking and sleeping late were risk factors for viral hepatitis secondary cirrhosis(P<0.05).Conclusions The levels of serum MMP-2,TIMP-1,Cys-C,HA,PCⅢand LN were significantly increased in the elderly patients with viral hepatitis secondary cirrhosis.Antiviral and hepatoprotective treatments can effectively reduce the risk of secondary cirrhosis,while drinking and sleeping late will aggravate the process of cirrhosis.Emphasis should be placed on the intervention of these factors.