胆道闭锁患儿血清白细胞衍生趋化因子2、血管紧张素转化酶2、尿激酶纤溶酶原激活物受体水平与肝纤维化和肝功能指标的关系研究

Study on the relationship between serum levels of leukocyte derived chemokine-2,angiotensin converting enzyme-2,urokinase plasminogen activator receptor and liver fibrosis and liver function indexes in children with biliary atresia

目的探讨胆道闭锁(BA)患儿血清白细胞衍生趋化因子2(LECT2)、血管紧张素转化酶2(ACE2)、尿激酶纤溶酶原激活物受体(uPAR)水平与肝纤维化和肝功能指标的关系。方法选择2018月6月—2020年3月在本院接受Kasai术治疗的83例BA患儿作为BA组,同时选取同期来本院体检的健康志愿儿童50名作为对照组。根据肝纤维化程度将BA组分为轻度肝纤维化组51例,重度肝纤维化组32例。对比术前BA组、对照组血清LECT2、uPAR、ACE2水平,观察轻度肝纤维化组和重度肝纤维化组手术前后血清LECT2、uPAR、ACE2水平、肝功能指标的变化,并采用Pearson相关性分析血清LECT2、uPAR、ACE2水平与肝功能指标的相关性。结果BA组血清ACE2水平低于对照组(P<0.05),LECT2、uPAR水平高于对照组(P<0.05)。轻度肝纤维化组术前ACE2、白蛋白(ALB)高于重度肝纤维化组,LECT2、uPAR、总胆红素(TB)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)低于重度肝纤维化组(P<0.05)。术后2个月,两组ACE2、ALB升高,且轻度肝纤维化组高于重度肝纤维化组(P<0.05);术后2个月,两组LECT2、uPAR、TB、ALT及ALP降低,且轻度肝纤维化组低于重度肝纤维化组(P<0.05)。Pearson相关性分析结果显示,ACE2与ALB呈正相关,而与TB、ALT、ALP呈负相关(P<0.05)。LECT2、uPAR与ALB呈负相关,而与TB、ALT、ALP呈正相关(P<0.05)。结论血清LECT2、uPAR、ACE2水平与BA患儿肝纤维化和肝功能关系密切,可考虑作为BA疾病进展的非侵入性检测指标。

Objective To investigate the relationship between serum levels of leucocyte derived chemokine 2(LECT2),angiotensin converting enzyme 2(ACE2),urokinase plasminogen activator receptor(uPAR)and liver fibrosis and liver function indexes in children with biliary atresia(BA).Methods 83 cases of children with BA who were treated with Kasai surgery in our hospital from June 2018 to March 2020 were selected as BA group,and 50 healthy volunteer children who came to our hospital for physical examination in the same period were selected as the control group.According to the results of hepatic fibrosis,BA group was divided into mild hepatic fibrosis group(51 cases)and severe hepatic fibrosis group(32 cases).The serum levels of LECT2,uPAR and ACE2 were compared between BA group and control group before operation.The changes of serum levels of LECT2,uPAR,ACE2 and liver function indexes before and after operation were observed in mild hepatic fibrosis group and severe hepatic fibrosis group.Pearson correlation analysis was used to analyze the correlation between serum levels of LECT2,uPAR,ACE2 and liver function indexes.Results The serum level of ACE2 in BA group was lower than that in control group(P<0.05),the levels of LECT2 and uPAR were higher than those in control group(P<0.05).The ACE2 and albumin(ALB)in mild hepatic fibrosis group were higher than those in severe hepatic fibrosis group before operation,while LECT2,uPAR,total bilirubin(TB),alanine aminotransferase(ALT)and alkaline phosphate(ALP)were lower than those in severe hepatic fibrosis group(P<0.05).2 months after operation,ACE2 and ALB in both two groups increased,and those in mild hepatic fibrosis group were higher than those in severe hepatic fibrosis group(P<0.05).2 months after operation,LECT2,uPAR,TB,ALT and ALP in two groups decreased,and those in mild hepatic fibrosis group were lower than those in severe hepatic fibrosis group(P<0.05).Pearson correlation analysis showed that ACE2 was positively correlated with ALB,but negatively correlated with TB,ALT and ALP(P<0.05).LECT2 and uPAR were negatively correlated with ALB,but positively correlated with TB,ALT and ALP(P<0.05).Conclusions The serum levels of LECT2,uPAR and ACE2 are closely related to hepatic fibrosis and liver function in children with BA,so they should be considered as non-invasive indicators of BA disease progression.