慢性乙型肝炎患者血清促肝细胞生长素的临床意义研究

目的测定慢性乙型肝炎(CHB)患者不同临床类型组血清促肝细胞生长素(HGF)水平,分析HGF水平与临床类型、肝功能水平、乙肝病毒血清标志物(HBVM)和HBV-DNA的关系,探讨HGF在CHB的意义。方法用酶联免疫吸附试验(ELISA)法检测78例CHB患者不同临床类型组血清HGF水平,与肝功能完全正常的20例健康体检者作对照,同时检测肝功能、乙肝两对半和HBV-DNA,部分病人进行了HbsAg定量测定和PT测定。结果 78例CHB患者血清HGF水平为(929.10±1932.15)pg/ml;健康对照组HGF水平分别为(215.1±65.97)pg/ml,两组HGF水平差异有统计学意义。78例慢性乙型肝炎患者中,抗病毒治疗应答组、HbeAg+CHB组、HbeAg-CHB组与肝衰竭组HGF水平分别为(658.20±178.20)pg/ml、(772.60±335.40)pg/ml、(958.80±1 005.49)pg/ml与(5 912.0±4 497.0)pg/ml,各组HGF水平均高于对照组。4个临床类型组两两比较,肝衰竭组HGF水平最高,与其余各组相比,差异具有统计学意义;HBeAg-CHB组HGF水平>抗病毒组,差异有统计学意义(P<0.01);HbeAg-CHB组HGF水平>HbeAg+CHB组及HbeAg+CHB组>抗病毒组,但差异无统计学意义(P>0.005)。高、低病毒载量组HGF水平分别为(2 141.0±3 115.3)pg/ml与(812.50±639.80)pg/ml,差异无统计学意义(P>0.05)。HbsAg载量高与低组HGF水平分别为(1 258.0±2813.3)与(1794.09±5 033.0)pg/ml,差异无统计学意义。炎症活动CHB组63份病例HGF与ALT、AST、Tbil相互关系经Spearman等级相关检验,相关系数有统计学意义(P<0.05),呈正相关,其中HGF与Tbil呈高度正相关。HGF与HBV-DNA相互关系经Spearman等级相关检验,相关系数无统计学意义(P>0.05)。结论 1.HGF在不同临床类型CHB患者血清中都明显升高,说明HGF参与了HBV感染后的免疫反应、肝脏损伤和修复过程;2.肝衰竭组血清HGF明显高于其余各临床类型组,临床使用肝细胞生长素治疗肝衰竭的时机需进一步评价;3.HGF与肝损伤程度有关,与HBV-DNA及HbsAg载量无明显相关性。

The study of the clinical significance of HGF of serum in chronic hepatitis B.

Objective To measure the levels of hepatocyte growth factor(HGF) in serum of different clinical types of chronic hepatitis B and analyze them trying to find a relationship with different clinical types,the levels of liver function,HBVM and HBVDNA,probing the clinical significance of HGF in the treatment of chronic hepatitis B.Methods The levels of HGF in serum of 78 subjescts with chronic hepatitis had been measured with ELISA.20 with normal liver function healthy subjects whose HGF also had been measured were chosen as the contrast group.Meanwhile,all the subjects had been measured about their liver function,HBsAg,HBsAb,HBeAg,HBeAb,HbcAb and HBV-DNA,and some patients’ HbsAg levels and PT also had been measured.Results The levels of HGF in chronic hepatitis B group were(929.10 ± 1932.15)pg/ml,while in the healthy control group,the levels of HGF were(215.1 ± 65.97)pg/ml.These two data had statistically significant difference.In Anti-virus group,HbeAg+ CHB group,HBeAg﹣CHB group and liver failure group,the levels of HGF were(658.20±178.20)pg/ml,(772.60±335.40)pg/ml,(958.80±1005.49)pg/ml and(5912.0 ± 4497.0)pg/ml.The levels of HGF in these groups were all higher than that of healthy control group(P<0.0125).The level of HGF in the liver failure group was the highest compared with the other four groups,and the difference was statistically significant(P <0.008).The level of HGF in HBeAg-CHB group > the level of HGF in Anti-virus group and the differences were statistically significant(P<0.008).The level of HGF in HBeAg﹣CHB group > the level in HbeAg+ CHB group and the level of HGF in HbeAg+ CHB group > the level of HGF in Anti-virus group,but the difference was not statistically significant(P>0.008).The levels of HGF in high and low viral loadgroups were(2 141.0±3 115.3)pg / ml and(812.50±639.80) pg/ml respectively,there was no statistically significant difference(P>0.05).The level of HGF of the load of HbsAg in the high and low groups were(1 258.0±2 813.3)and(1 794.09±5 033.0)pg/ml,there was no different statistical significance.HGF and Tbil had a high degree of positive correlation.In the relationship between HGF and HBV-DNA tested by the Spearman rank correlation,the correlation coefficient was not statistically significant(P>0.05).The HGF and inflammatory activity of chronic HBV infection showed a high degree of positive correlation,and the correlation coefficient was statistically significant(P <0.05).Conclusion 1.HGFs in different types of chronic hepatitis B are significantly higher in serum,indicating that HGF has involved in the immune response,liver injury and reconditioning to HBV infection process;2.The levels of HGF in hepatic failure group are significantly higher than that of the rest of the clinical types,which show that abnormal increasing of the levels of HGF might be related to one of the reasons of hepatic failure.In addition,the role of HGF in the treatment of liver failure needs further evaluation;3.HGFs are related to the degree of liver injury,and have no significant correlation with the loads of HBV-DNA and HbsAg.