吉林地区不同肝病患者血清铜蓝蛋白水平分析

目的探讨不同病因、不同疾病阶段的肝病患者血清铜蓝蛋白水平。方法选取吉林大学第一医院肝胆胰内科2012年1月-2018年1月住院的共1077例肝病患者,分析不同肝病患者的血清铜蓝蛋白水平。应用Kruskal-Wallis H检验比较不同肝功能状态的病毒相关性肝病患者的铜蓝蛋白水平,应用Spearman相关性分析方法评估铜蓝蛋白与其他指标之间的相关性。结果在肝豆状核变性组,97.6%(41/42)的患者血清铜蓝蛋白水平低于0.2 g/L,其中88.1%(37/42)低于0.10 g/L。不同肝功能状态的病毒相关性肝病患者血清铜蓝蛋白水平差异显著,其中慢性病毒性肝炎、重症病毒性肝炎以及病毒性肝炎肝硬化患者的血清铜蓝蛋白水平均低于急性病毒性肝炎和病毒相关性肝癌患者(P值分别为0.005、<0.001、0.001、0.027、<0.001、0.001)。在非肝豆状核变性肝病组,24.3%(251/1035)的患者铜蓝蛋白低于0.2 g/L,0.2%低于0.1 g/L。非肝豆状核变性肝病患者的血清铜蓝蛋白与白蛋白、前白蛋白呈正相关,与凝血酶原时间呈负相关(r值分别为0.068、0.091和-0.297,P值均<0.05)。结论铜蓝蛋白在肝豆状核变性中通常显著下降,在其他肝病中也可能略有下降。对于这些患者,应注意鉴别铜蓝蛋白下降是疾病本身肝细胞损伤所致,还是确实存在肝豆状核变性。

Serum level of ceruloplasmin in patients with different liver diseases in Jilin,China

Objective To investigate the serum level of ceruloplasmin in patients with different stages and etiologies of liver diseases.Methods A total of 1077 patients with liver diseases who were hospitalized in Department of Hepatology,The First Hospital of Jilin University,from January 2012 to January 2018 were enrolled,and the serum level of ceruloplasmin was analyzed for the patients with different liver diseases.The Kruskal-Wallis H test was used to compare the level of ceruloplasmin between the patients with virus-related liver diseases with different liver functional states,and a Spearman correlation analysis was used to investigate the correlation of ceruloplasmin with other biomarkers.Results In the Wilson’s disease group,97.6%(41/42)of the patients had a serum ceruloplasmin level of<0.2 g/L and 88.1%(37/42)had a level of<0.1 g/L.In the non-Wilson’s disease group,24.3%(251/1035)of the patients had a ceruloplasmin level of<0.2 g/L and 0.2%had a level of<0.1 g/L.There was a significant difference in the serum level of ceruloplasmin between the patients with virus-related liver diseases with different liver functional states,and the patients with chronic viral hepatitis,severe viral hepatitis,and viral hepatitis cirrhosis had a significantly lower level than those with acute viral hepatitis and virus-related liver cancer(P=0.005,P<0.001,P=0.001,P=0.027,P<0.001,and P=0.001).In the patients without Wilson’s disease,serum ceruloplasmin was positively correlated with albumin and prealbumin(r=0.068 and 0.091,both P<0.05)and was negatively correlated with prothrombin time(r=-0.297,P<0.05).Conclusion Ceruloplasmin often decreases significantly in patients with Wilson’s disease,with a slight reduction in patients with other types of liver diseases.For these patients,it should be determined whether the reduction in ceruloplasmin is caused by hepatocyte injury or the presence of Wilson’s disease.