血浆铜蓝蛋白在乙型肝炎不同肝功能状态的水平及意义

摘要

Objective To clarify the difference and significance of ceruloplasmin levels in patients with Wilson's disease and chronic hepatitis B patients with different liver function status. Methods Model for end-stage liver disease (MELD) was used to measure severities of liver function injury. The levels of ceruloplasmin in patients with Wilson' s disease, patients at the fastigium and convalescent period of acute-on-chronic liver failure with hepatitis B and in patients with chronic hepatitis B were measured by nephelometric immunoassay. Results The MELD scores in patients with Wilson' s disease (re =50) , fastigum and convalescent period of acute-on-chronic liver failure with hepatitis B (n = 30) , chronic hepatitis B (re =50) were 11.1 ?. 5 , 20. 4 ?. 2 , 10.9 ?.9 and 9. 6 ?. 8, respectively, and the levels of ceruloplasmin in those patients were (0.065 ?.036)g/L, (0. 176 ?.037)g/L, (0.210 ?.056)g/L and (0. 197 ?. 038 ) g/L, respectively. There were statistically significant differences among the four groups(F=111.4 , P <0.001). The level of ceruloplasmin in Wilson's disease patients was significant lower than that in the other groups (P<0.001). Conclusion Ceruloplasmin level is remarkably decreased in patients with Wilson's disease. Compared with Wilson's disease, ceruloplasmin level is almost normal in patients with chronic hepatitis B without liver failure. Ceruloplasmin level just is decreased slightly at the fastigium of acute-on-chronic liver failure with hepatitis B and returned to normal level along with the recovery of liver failure.%目的 探讨肝豆状核变性、乙型肝炎不同肝功能状态时血浆铜蓝蛋白水平的差异及其临床意义.方法 用终末期肝病模型(model for end-stage liver disease,MELD)评分衡量肝功能损害的严重性,采用散射比浊法检测并比较分析肝豆状核变性、慢加急性肝衰竭极期以及恢复期、慢性乙型肝炎患者的血浆铜蓝蛋白水平.结果 肝豆状核变性(n=50)、慢加急性肝衰竭极期和恢复期(n=30)、慢性乙型病毒性肝炎患者(n=50)的MELD评分分别为11.1±6.5、20.4±4.2、10.9 ±4.9、9.6±9.8,血浆铜蓝蛋白分别为(0.065±0.036) g/L、(0.176±0.037)g/L、(0.210 ±0.056) g/L、(0.197±0.038) g/L;血浆铜蓝蛋白水平4组之间的两两比较存在差异(F=111.4,P＜0.001),肝豆状核变性患者低于其他3组(P＜0.001).结论 肝豆状核变性血浆铜蓝蛋白水平显著降低.相对于肝豆状核变性,没有肝衰竭的慢性乙型肝炎血浆铜蓝蛋白水平几乎正常.慢加急性肝衰竭极期血浆铜蓝蛋白水平仅轻度下降,随着肝功能衰竭的恢复,血浆铜蓝蛋白恢复正常.