肝硬化伴肝癌患者血氨、甲胎蛋白、胆碱酯酶、肝纤维化指标与Child-Pugh分级的相关性

摘要

目的:探讨肝硬化伴肝癌(LC-HCC)患者血氨(NH3)、甲胎蛋白(AFP)、胆碱酯酶(ChE)及肝纤维化指标与Child-Pugh分级的关系.方法:选取LC合并HCC患者58例(LC-HCC组)、LC失代偿期76例(LC组)及同期健康体检者60例(HC组).采用化学发光法测定AFP,采用化学发光免疫分析法检测透明质酸(HA)、层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C),采用丁酰基硫代胆碱法测定ChE,连续监测NH3.比较LC-HCC、LC、HC三组间,LC-HCC组不同Child-Pugh分级间的AFP、ChE、NH3及肝纤维化指标(HA、LN、Ⅳ-C)水平变化.结果:LC-HCC组的NH3、血清AFP、HA、LN、Ⅳ-C水平显著高于LC组及HC组,ChE水平显著降低,且LC组与HC组比较差异均有统计学意义(P<0.05);LC-HCC组随着Child-pugh等级上升,NH3、血清AFP、HA、LN、Ⅳ-C水平逐渐升高而ChE逐渐降低,差异有统计学意义(P<0.05);LC-HCC患者的血清ChE与Child-pugh分级呈显著负相关(P<0.05),AFP、NH3、LN、Ⅳ-C及HA与Child-pugh分级呈显著正相关(P<0.05);LC-HCC患者的ChE与LN、Ⅳ-C及HA呈显著负相关(P<0.05),AFP、NH3与LN、Ⅳ-C及HA呈显著正相关(P<0.05).结论:LC-HCC患者存在明显的血清AFP、ChE和NH3异常,且与肝纤维化指标及Child-pugh分级密切相关,联合检测对HCC的无创性诊断具有重要价值.%Objective:To investigate the relationship between the level of plasma ammonia(NH3),and the changes of serum alpha-fetoprotein(AFP),cholinesterase(ChE),liver fibrosis index in liver cirrhosis patients with hepatocellular carcinoma(LC-HCC)in reference to Child-pugh grades.Methods: A total of 58 patients with LC and HCC(LC-HCC group),76 patients with LC(LC group)and 60 cases of healthy volunteers(HC group)were collected.Serum AFP were detected by electrochemiluminescence,serum Hyaluronic acid(HA),laminin(LN),type Ⅳ collagen(Ⅳ-C) were detected by chemilu minescence immunoassay,serum ChE were detected by S-Butyrylthiocholine iodide,NH3 was continuously monitored.The levels of AFP,ChE,NH3 and liver fibrosis indexes(HA,LN,Ⅳ-C) among the LC-HCC group,LC group and HC group,different Child-Pugh grades in LC-HCC group were compared.Results: The serum levels of NH3,AFP,HA,LN,Ⅳ-C in LC-HCC group were significantly higher than that in LC and HC group,and ChE levels were significantly reduced,differences between LC group and HC group were statistically significant(P<0.05).With the increase of Child-Pugh grades,the serum levels of NH3,AFP,HA,LN,Ⅳ-C in LC-HCC group were gradually increased but the ChE gradually decreased,the differences were statistically significant(P<0.05).Serum levels of ChE in patients with LC-HCC were significant negatively correlated with Child-Pugh grades,and AFP,NH3,HA,LN,Ⅳ-C were significant positive correlated with Child-Pugh grades(P<0.05).Serum levels of ChE in patients with LC-HCC were significant negatively correlated with LN,Ⅳ-C and HA,while the levels of AFP,NH3 were significant positive correlated with LN,Ⅳ-C and HA(P<0.05).Conclusion: The serum levels of AFP,ChE and NH3 in patients with LC and HCC are significant abnormalities;they are significant positive correlated with Child-Pugh grades;the detection of the these indicators is valuable to non-invasive diagnosis for patients with LC and HCC.