原发性胆汁性肝硬化患者血脂、载脂蛋白A1、载脂蛋白B水平变化及其临床意义

Changes of lipid,apolipoprotein A1 and apolipoprotein B levels in patients with primary biliary cirrhosis and their clinical significance

目的探究原发性胆汁性肝硬化患者血脂、载脂蛋白A1、载脂蛋白B水平变化及其临床意义。方法选择65例原发性胆汁性肝硬化患者为病例组,另选同期65例健康体检者为对照组。两组均进行血脂(甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)、载脂蛋白A1、载脂蛋白B检测。比较两组的血脂、载脂蛋白A1、载脂蛋白B水平。以Child-Pugh评分将病例组分为Child-Pugh A级亚组(23例)、Child-Pugh B级亚组(23例)、Child-Pugh C级亚组(19例),比较不同Child-Pugh分级亚组的血脂、载脂蛋白A1、载脂蛋白B水平。分析原发性胆汁性肝硬化患者Child-Pugh评分与载脂蛋白A1、载脂蛋白B、血脂的相关性。结果病例组的甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B水平分别为(1.62±0.40)mmol/L、(4.11±0.66)mmol/L、(2.32±0.48)mmol/L、(1.12±0.16)mmol/L、(0.99±0.27)g/L、(0.69±0.21)g/L,对照组分别为(1.41±0.36)mmol/L、(3.92±0.56)mmol/L、(2.15±0.55)mmol/L、(1.26±0.13)mmol/L、(1.32±0.09)g/L、(0.70±0.21)g/L。病例组与对照组的总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B水平比较差异无统计学意义(P>0.05);病例组患者的载脂蛋白A1、高密度脂蛋白胆固醇显著低于对照组,甘油三酯明显高于对照组(P<0.05)。Child-Pugh A级亚组与Child-Pugh B级亚组的载脂蛋白B、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇比较差异无统计学意义(P>0.05);Child-Pugh B级亚组的载脂蛋白A1低于Child-Pugh A级亚组(P<0.05)。Child-Pugh C级亚组患者的载脂蛋白A1、载脂蛋白B、高密度脂蛋白胆固醇明显低于Child-Pugh A级亚组、Child-Pugh B级亚组,甘油三酯、总胆固醇、低密度脂蛋白胆固醇明显高于Child-Pugh A级亚组、Child-Pugh B级亚组(P<0.05)。经Pearson相关分析显示,Child-Pugh评分与载脂蛋白A1、载脂蛋白B、高密度脂蛋白胆固醇呈负相关,与甘油三酯、总胆固醇、低密度脂蛋白胆固醇呈正相关(P<0.05)。结论原发性胆汁性肝硬化患者存有载脂蛋白A1、高密度脂蛋白胆固醇、甘油三酯表达异常,而随着病情加重患者血脂、载脂蛋白均会出现异常改变,脂代谢紊乱加剧,值得进一步深入研究。

Objective To explore the changes of lipid,apolipoprotein A1 and apolipoprotein B levels in patients with primary biliary cirrhosis and their clinical significance.Methods 65 patients with primary biliary cirrhosis were selected as the case group,and 65 healthy subjects during the same period were selected as the control group.Both groups were tested for lipids(triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol),apolipoprotein A1,and apolipoprotein B.The lipid,apolipoprotein A1 and apolipoprotein B levels of the two groups were compared.According to Child-Pugh score,the case group was divided into Child-Pugh grade A subgroup(23 cases),Child-Pugh grade B subgroup(23 cases),and Child-Pugh grade C subgroup(19 cases).The levels of lipid,apolipoprotein A1 and B in different Child-Pugh subgroups were compared.Results The levels of triglyceride,total cholesterol,lowdensity lipoprotein cholesterol,high-density lipoprotein cholesterol,apolipoprotein A1 and apolipoprotein B in the case group were(1.62±0.40)mmol/L,(4.11±0.66)mmol/L,(2.32±0.48)mmol/L and(1.12±0.16)mmol/L,(0.99±0.27)g/L,(0.69±0.21)g/L,and those of the control group were(1.41±0.36)mmol/L,(3.92±0.56)mmol/L,(2.15±0.55)mmol/L,(1.26±0.13)mmol/L,(1.32±0.09)g/L and(0.70±0.21)g/L.There was no significant difference in the levels of total cholesterol,low-density lipoprotein cholesterol and apolipoprotein B between the case group and the control group(P>0.05).The apolipoprotein A1 and high density lipoprotein cholesterol in the case group were significantly lower than those in the control group,and the triglyceride was significantly higher than that in the control group(P<0.05).The apolipoprotein B,triglyceride,total cholesterol,low density lipoprotein cholesterol and high density lipoprotein cholesterol were compared between Child-Pugh grade A subgroup and Child-Pugh grade B subgroup,and the difference was not statistically significant(P>0.05).Apolipoprotein A1 in Child-Pugh grade B subgroup was lower than that in Child-Pugh grade A subgroup(P<0.05).The Apolipoprotein A1,apolipoprotein B,and high-density lipoprotein cholesterol in Child-Pugh grade C subgroup were significantly lower than those in the Child-Pugh grade A subgroup and Child-Pugh grade B subgroup;the triglycerides,total cholesterol,and low-density lipoprotein cholesterol in Child-Pugh grade C subgroup were significantly higher than those in the Child-Pugh grade A subgroup and Child-Pugh grade B subgroup(P<0.05).As shown by Pearson correlation analysis,Child-Pugh score was negatively correlated with apolipoprotein A1,apolipoprotein B,and high-density lipoprotein cholesterol,and positively correlated with triglyceride,total cholesterol,and low-density lipoprotein cholesterol(P<0.05).Conclusion Patients with primary biliary cirrhosis have abnormal expression of apolipoprotein A1,high-density lipoprotein cholesterol,and triglycerides.However,as the condition worsens,patients will experience abnormal changes in blood lipids and apolipoprotein,exacerbating lipid metabolism disorders,which is worthy of further in-depth research.