肝硬化及原发性肝癌患者血清半胱氨酸蛋白酶抑制剂C水平的改变及其意义

摘要

目的 探讨血清半胱氨酸蛋白酶抑制剂C (Cys C)水平在肝硬化和原发性肝癌(PLC)患者中的变化及其临床意义.方法 采用胶乳增强免疫透射比浊法测定90例肝硬化、153例PLC及95例肝脏良性病变患者(对照组,包括肝血管瘤、肝囊肿)血清Cys C水平,同时采用酶法检测血清肌酐(SCr)及尿素(Urea)水平.分析Cys C、SCr、Urea在肝硬化、PLC和对照组间的差异以及Cys C与SCr、Urea之间的相关性.按照Child-Pugh标准对肝硬化患者的肝功能进行分级,对肝功能不同等级间Cys C、SCr、Urea水平进行比较.结果 肝硬化组血清Cys C水平为(1.04±0.24) mg/L,肝癌组为(0.98±0.28) mg/L,均高于对照组[(0.78±0.18) mg/L] (P＜0.001),肝硬化组亦高于肝癌组(P＜0.05).肝硬化组和肝癌组Urea和SCr水平无明显差异,但均明显高于对照组(P＜0.05).血清Cys C与SCr呈正相关(肝硬化、肝癌和对照组的r值分别为0.407、0.673、0.511,(P均＜0.001).肝硬化组和肝癌组中血清Cys C异常率均明显高于SCr及Urea(P均＜0.001).肝硬化Child-Pugh B+C级血清Cys C水平[(1.12±0.21) mag/L]显著高于Child-Pugh A级[(0.99±0.25) mg/L] (P ＜0.05).结论 血清Cys C水平随着肝病的进展和患者肝功能的衰退而升高,且比SCr和Urea更能灵敏的反映慢性肝病患者的早期肾损伤.%Objective To investigate the change and clinical significance of serum cystatin C (Cys C)level in patients with liver cirrhosis and primary liver carcinoma (PLC). Methods Serum Cys C levels were detected in 90 cases of liver cirrhosis, 153 cases of PLC and 95 cases of benign liver disease (liver hemangioma and hepatic cyst)as controls by latex particle enhanced immuno-turbidimetry, while serum creatinine (SCr)and urea were detected by enzymic method. The differences of serum Cys C, SCr and urea levels and their relationship were analyzed between the groups. The Cys C, SCr and urea levels were analyzed according to the liver function Child-Pugh grade. Results Serum Cys C level was significantly higher in liver cirrhosis group [(1.04±0. 24)mg/L] and PLC group [ (0. 98 ± 0.28)mg/L] than that in control group [ (0.78 ±0.18)mg/L] , (P <0.001), and the Cys C level in liver cirrhosis group was higher than that in PLC group (P < 0.05 ). Serum SCr and urea levels in liver cirrhosis and PLC groups were also significantly higher than that in control group (P < 0. 05 ), but there was no significant difference between liver cirrhosis and PLC groups. There was significant positive correlation between serum Cys C and SCr levels (liver cirrhosis group; r =0.407, PLC group: r = 0.673 and control group: r =0.511, P<0.001). The abnormal rates of Cys C were significantly elevated in both liver cirrhosis and PLC groups than those of SCr and urea (P < 0.001). Serum Cys C level was significantly higher in Child-Pugh B + C group [ (1.12 ±0.21)mg/L] than that in Child-Pugh A group [ (0.99 ± 0.25 )mg/L] among the liver cirrhosis group(P < 0.05 ). Conclusions Serum Cys C increases with the progression of liver disease and severity of liver failure, and it indicates early renal disfunction better than SCr and urea in patients with chronic liver disease.