人前心钠肽在肝病诊断中的价值

目的:检测肝病患者血清中人前心钠肽(proatrial natriuretic peptide,proANP)水平,评价proANP在肝病患者中的诊断价值.方法:收集我院住院患者中肝功能检查异常的、经临床和实验室检查证实无细菌感染患者血清32例(其中肝硬化13例、原发性肝癌12例、药物性肝炎3例、慢性重度乙型肝炎4例)作观察组,选择20例来我院作健康体检的成人血清作对照组,同时进行proANP检测.结果:正常对照组成人血清proANP浓度分别与肝硬化组、原发性肝癌组、药物性肝炎组和慢性重度乙型肝炎组患者血清proANP浓度比较,均有显著性差异(t=8.970,9.088,3.826,8.240,均P<0.001).各肝病组间进行比较,慢性重度乙型肝炎组与其他3组比较差异有显著性,其余各组间差异无显著性.结论:血清中proANP水平增高,对多种肝病患者的诊断具有一定的诊断价值.     

High serum glyceraldehyde-3-phosphate dehydrogenase levels in patients with liver cirrhosis

We have developed a mouse monoclonal antibody against glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and established a form of semi-quantitative latex particle aggregation as a first-screening technique for determining serum levels of GAPDH. Focusing on chronic liver diseases, we measured serum GAPDH in 213 patients to clarify its clinical significance. Serum GAPDH levels were similar in healthy control subjects, patients who were hepatitis B or C virus carriers, or with chronic hepatitis. However, the levels were significantly increased in patients with cirrhosis (P<0.001). Logistic regression analysis indicated that the presence of hepatocellular carcinoma and a high γ-globulin level were closely associated with high GAPDH levels (P=0.006 and 0.011, respectively). Elevated serum GAPDH was also confirmed in a patient with cirrhosis associated with hepatocellular carcinoma using Western blotting analysis. The mechanism(s) of serum GAPDH elevation remains unclear, but one possible source is increased leakage of the GAPDH molecule into the serum from damaged cirrhotic hepatocytes underlying hepatocarcinogenesis or chronic inflammation.     

Serum matrix metalloproteinase-3 (stromelysin-1) concentration in patients with chronic liver disease.

BACKGROUND/AIMS: Matrix metalloproteinase (MMP)-3 plays an important role in extracellular matrix degradation, because of its broad substrate specificity and its activation of other proMMPs. Our aims in the present study were to determine whether the measurement of serum MMP-3 is clinically useful for assessing ongoing liver fibrolysis in patients with chronic liver disease. METHODS: We measured the serum MMP-3 concentrations with a sandwich enzyme immunoassay in 58 patients with chronic hepatitis, 22 patients with liver cirrhosis, 45 patients with hepatocellular carcinoma and 124 healthy individuals. The liver MMP-3 content was also measured in autopsied livers. RESULTS: Among the healthy controls, the serum levels of MMP-3 were about 2-fold higher in the males than in the females. In this study, the serum MMP-3 results of mainly the male group were analyzed because of the large number of male subjects. Compared to the control level, the mean serum MMP-3 concentration was 55% lower in chronic hepatitis, 53% lower in liver cirrhosis and 46% lower in hepatocellular carcinoma. There was no significant difference in the serum MMP-3 levels among the chronic hepatitis, liver cirrhosis and hepatocellular carcinoma groups. The serum MMP-3 levels were not related to the histological degree of necroinflammation or of liver fibrosis in the patients with chronic hepatitis. No significant difference in serum MMP-3 levels was observed among three Child's subgroups in the group of cirrhotic patients. In the group of patients with hepatocellular carcinoma, the serum MMP-3 levels were not related to the severity of liver function, the HCC tumor size, or the histological differentiation. The serum MMP-3 level was not correlated with serum markers for connective tissue turnover, i.e. procollagen type III peptide, 7S fragment of type IV collagen, hyaluronan and tissue inhibitor of metalloproteinase-1 in the patients with chronic liver disease or hepatocellular carcinoma. CONCLUSIONS: The measurement of serum MMP-3 is of little use for assessing fibrolysis in chronically diseased livers.     

肝病患者血清肉碱水平的临床研究

目的观察肝病患者血清肉碱水平,探讨其临床意义,为肉碱治疗肝病提供依据。方法用酶循环法检测25例急性病毒性肝炎,34例慢性病毒性肝炎,22例肾功能正常及9例肾功能异常的肝炎后肝硬化患者血清游离肉碱水平,并分别与40名正常人的检测值比较。结果血清游离肉碱:正常人为(48．3±10．2)μmol／L;急性病毒性肝炎患者为(35．2±13．2)μmol／L,明显低于正常对照组,P=0．000。慢性病毒性肝炎患者为(36．5±9．9) μmol／L,明显低于正常对照组,P=0．000。肾功能正常的肝炎后肝硬化患者为(45．0±11．0)μmol／L,比正常对照组略有下降,但差异无统计学意义,P=0．232。肾功能异常的肝炎后肝硬化患者为(83．6±50.4)μmol／L,比正常对照组升高,但差异无统计学意义,P=0．069。结论肝病患者可发生肉碱代谢异常,肝脏疾病是导致继发性肉碱缺乏的原因之一。     

Urinary Pseudouridine as a Biochemical Marker in the Diagnosis and Monitoring of Primary Hepatocellular Carcinoma

The urinary level of pseudouridine, primarily a degradation product of transfer ribonucleic acid (tRNA), was determined in 38 patients with primary hepatocellular carcinoma, 18 with liver cirrhosis, 12 with chronic hepatitis, nine with acute hepatitis, and 28 healthy subjects. The mean urinary pseudouridine concentration was significantly higher in the patients with hepatoma [38.2 +/- 12.8 (SD) nmol/mumol creatinine] than in those with liver cirrhosis (20.3 +/- 6.8), chronic hepatitis (24.4 +/- 8.2), and acute hepatitis (21.7 +/- 8.2), and in healthy subjects (23.8 +/- 4.9). Urinary pseudouridine level was elevated above the mean value plus 2 SD for the healthy subjects (33.6 nmol/mumol creatinine) in 71% of our hepatoma cases. Serum alpha-fetoprotein levels correlated poorly with urinary pseudouridine levels, thus, the combination assay for urinary pseudouridine and serum alpha-fetoprotein could detect 79% of the patients with hepatoma. Moreover, urinary pseudouridine level was reduced after effective transcatheter arterial embolization therapy.     

The serum protein profile in chronic hepatitis, cirrhosis and liver cancer.

Using the single radial immunodiffusion method, the serum levels of IgG, IgA, Ig M, transferrin, haptoglobin, alpha2-macroglobulin, alpha1-antitrypsin and alpha1-acid glycoprotein were estimated in healthy subjects and patients with liver diseases consisting of chronic active and inactive hepatitis, incipient cirrhosis, cirrhosis and primary liver cancer. The results obtained from the statistical analysis of the data were as follows: i) Immunoglobulins and alpha2-macroglobulin in all diseases were higher than those of healthy subjects. ii) The increased transferrin levels were found in chronic active and inactive hepatitis, and the increased alpha1-antitrypsin levels were observed in chronic inactive hepatitis, in incipient cirrhosis in cirrhosis and in primary liver cancer was higher than those of the other liver diseases. iii) Haptoglobulin levels in all diseases except for chronic inactive hepatitis were decreased. iv) alpha1-acid glycoprotein in chronic active hepatitis, in incipient cirrhosis and in cirrhosis were lower than that of healthy subjects. The evaluation of significance for difference of each protein level among disease groups clarified that the decrease of haptoglobin in cirrhosis and the increase of alpha1-antitrypsin in primary liver cancer were characteristic change respectively.     

Serum thioredoxin levels as an indicator of oxidative stress in patients with hepatitis C virus infection

BACKGROUND/AIM: It has recently been suggested that oxidative stress may be associated with hepatitis C virus (HCV) infection. Thioredoxin (TRX) is a stress-inducible thiol-containing protein. The aim of this study was to evaluate the clinical significance of serum TRX levels in patients with HCV-related chronic liver diseases. METHODS: Serum TRX levels were determined with a sandwich enzyme-linked immunosorbent assay kit in 174 serum HCV-RNA positive patients, including 6 asymptomatic carriers, 124 chronic hepatitis, 20 liver cirrhosis, and 24 hepatocellular carcinoma, and in 15 healthy volunteers. RESULTS: The serum TRX levels (medians and [ranges], ng/ml) were significantly elevated in the HCV-infected patients; 30.9 [20.7-37.7] in asymptomatic carriers, 34.5 [8.6-135.6]* in chronic hepatitis, 42.5 [21.4-97.2]* in liver cirrhosis, and 43.9 [11.7-180.3]** in hepatocellular carcinoma (*p<0.05, **p<0.001, vs. 24.9 [1.3-50.7] in healthy controls). Serum TRX levels were significantly correlated with the serum levels of ferritin and fibrogenesis markers, and with the histological stage of hepatic fibrosis. The serum TRX levels before interferon treatment of patients whose serum HCV-RNA was still positive on day 14 following interferon treatment (42.6 [20.1-90.0]) were significantly higher than those of patients whose serum HCV-RNA was negative on day 14 following interferon treatment (25.8 [7.4-59.8], p<0.05). CONCLUSIONS: The serum TRX levels of patients with HCV infection increased with their serum ferritin levels and the progression of liver fibrosis. Patients with higher serum TRX levels exhibited resistance to interferon therapy. Oxidative stress may therefore be responsible for the pathological mechanism of HCV-related liver diseases and be one of the impediments to eradication of HCV during interferon treatment.     

血清前白蛋白在肝病中的临床意义

了解病毒性肝炎患者血清前白蛋白 (PA)的变化 ,探讨测定血清前白蛋白对病毒性肝炎患者的诊断价值。采用免疫比浊法检测 2 76例病毒性肝炎患者血清前白蛋白 ,比较不同临床类型的血清PA的水平及同一临床类型间PA与A的异常率。血清PA的水平在急性肝炎与轻度慢性肝炎之间、慢性肝炎轻度与中度、中度与重度之间、肝硬化与慢性重型肝炎之间均有显著性差异 (P <0 0 5 ) ;急性肝炎组PA与白蛋白 (A)两者相比有高度显著性差异 (P <0 0 0 1) ;PA值比A值更灵敏地反映肝功能损害。血清PA的水平持续 <10 0mg/L作为重症肝炎早期诊断指标之一。检测血清PA对病毒性肝炎临床诊断、病情判断和预后估计有一定参考价值     

Clinical Significance of Serum and Urinary Neopterin Levels in Patients with Various Liver Diseases

Serum and urinary neopterin levels were measured by radioimmunoassay in 120 healthy controls, 16 asymptomatic HBsAg carriers, 12 patients with acute hepatitis, 13 with chronic inactive hepatitis, 35 with chronic active hepatitis, 46 with liver cirrhosis, 18 with hepatocellular carcinoma, and 6 with alcoholic liver disease. Serum and urinary neopterin levels were significantly higher in almost all patients than in normal subjects. Neopterin levels were highest in acute hepatitis and correlated with the results of liver function tests, but did not show this correlation in chronic liver disease. In chronic liver disease, the levels of serum neopterin in non-A non-B viral patients was significantly increased, compared with those in B viral and alcoholic patients. The rate of abnormal urinary neopterin levels in chronic liver disease was higher than the rate of abnormal serum neopterin levels, but no difference was observed between the rates of abnormal serum and urinary levels in acute hepatitis and asymptomatic HBsAg carriers. These results indicate that serum and urinary neopterin levels may be useful markers for cell-mediated immunity in liver disease, and that the immune system response in chronic liver disease may be different for different pathogens.     

Macrophage colony stimulating factor and hepatitis

We investigated the serum level of macrophage colony stimulating factor (M-CSF) in patients with hepatitis using a newly developed radioimmunoassay (RIA). The mean level of M-CSF in patients with chronic active hepatitis was significantly higher than that of the healthy controls (P < 0.01). The mean level of M-CSF in patients with acute hepatitis in the acute phase was prominently higher than that of the patients with chronic active hepatitis (P < 0.001). However, in the convalescence phase of acute hepatitis, the mean level of M-CSF decreased to the lower level comparable to the mean level of the patients with chronic active hepatitis. These data suggest that the serum level of M-CSF is one of the factors which represents the inflammatory activity of liver diseases.     

Increased serum soluble interleukin 2 receptor levels in patients with viral liver diseases

Soluble interleukin 2 receptors (sIL 2R) in the sera of patients with viral liver diseases were quantified with a solid-phase enzyme immunoassay using two monoclonal antibodies against the receptors. The sIL 2R levels in patients with acute hepatitis, chronic hepatitis, liver cirrhosis and hepatocellular carcinoma were significantly higher than those in control subjects. In acute hepatitis patients, the high levels of sIL 2R observed during the florid stage returned to normal during remission. Levels in patients with chronic active hepatitis were significantly higher than in those with chronic persistent and lobular hepatitis, and levels observed during the exacerbation phase of chronic hepatitis were higher than they were during remission. Thus, in chronic hepatitis, sIL 2R levels increased in proportion to the inflammatory activity, and correlated well with serum transaminase (glutamic oxaloacetic transaminase: SGOT, glutamic pyruvic transaminase: SGPT) activities, but not with blood urea nitrogen or creatinine concentrations. In patients with a high degree of focal and piecemeal necrosis, serum sIL 2R levels increased further during recombinant interleukin 2 therapy. In post-hepatitic liver cirrhosis and hepatocellular carcinoma, sIL 2R levels correlated with serum cholinesterase and creatinine concentrations, but not with transaminase activities. Measurement of serum sIL 2R levels in patients with liver disease but without renal injury, may help in the diagnosis of inflammation in hepatitis, a process in which interleukin 2 may participate.     

Tenascin expression in human chronic liver disease and in hepatocellular carcinoma

Abstract: Tenascin is an oligomeric glycoprotein of the extracellular matrix synthesized during embryonic development. It is prominently expressed in a variety of tumors. The role of tenascin in liver tissue is, however, unknown. We used immunocytochemistry to define the localization of tenascin and compare this with the localization of non-collagenous proteins, such as laminin and fibronectin, in normal human liver and pathological liver from patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. In normal liver, tenascin expression was localized along the sinusoidal and vascular wall. In fibrotic liver, tenascin was also observed in the region between the hepatic parenchyma and the fibrosing portal tracts, especially in areas of piecemeal necrosis in chronic hepatitis. Immuno-EM study of liver tissue in chronic hepatitis strongly suggested the synthesis and secretion of tenascin by fat-storing cells into the space of Disse. In hepatocellular carcinoma, tenascin was expressed in both the capsule and lobular septa, but not in the sinusoidal walls of the tumors. These results led us to postulate a close relationship between the occurrence of this protein and disease processes such as fibrosis and cancer invasion.     

Erythrocyte 2,3-Diphosphoglycerate in Liver Diseases

The erythrocyte 2,3-diphosphoglycerate (2,3-DPG) was studied in patients with liver diseases, chronic obstructive pulmonary disease, and in normal subjects. The level of 2,3-DPG in liver diseases occurred in the following increasing order: chronic persistent hepatitis, chronic active hepatitis, liver cirrhosis, and cirrhosis with hepatocellular carcinoma. A significant negative correlation between the 2,3-DPG concentration and serum albumin concentration was found in the liver diseases. The 2,3-DPG level was correlated to the serum concentration of total bile acids and to the arterial blood pH. A negative correlation was found between the arterial blood pH and the serum albumin concentration. The level of 2,3-DPG in hepatocellular carcinoma and/or liver cirrhosis was higher than that in more hypoxic chronic obstructive pulmonary disease. And an increased level of 2,3-DPG was also shown in nonhypoxic patients with liver diseases. These results suggest that the level of erythrocyte 2,3-DPG increases according to the severity of the liver disease, and compared to the level in hypoxic chronic obstructive pulmonary disease, the level of erythrocyte 2,3-DPG is higher in both hepatocellular carcinoma and liver cirrhosis.     

Serum thyroglobulin in acute and chronic liver disease

In view of the widespread use of serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma, the influence of acute and chronic liver disease on serum thyroglobulin concentration was investigated in thirty-seven consecutive patients with histologically proven alcoholic liver cirrhosis and twenty-three patients with acute non-alcoholic hepatitis. Seventy-four healthy volunteers served as controls. Serum thyroglobulin concentration was significantly elevated in cirrhosis: median 29.5 micrograms/l, (range 4.3-94.0 micrograms/l) compared to controls: median 16.0 micrograms/l, (range 4.8-89.6 micrograms/l), (P less than 0.001). Serum thyroglobulin concentration in patients with acute hepatitis: median 16.2 micrograms/l, (range 7.9-70.0 micrograms/l) was not significantly different from controls. The level of free-T3-index was significantly reduced and the level of free-T4-index was significantly elevated in both cirrhosis and hepatitis compared to controls. Serum TSH concentration was significantly elevated in cirrhosis compared to hepatitis and controls. Serum thyroglobulin levels were positively correlated to levels of free-T3-index (r = 0.35, P less than 0.05) and T3/T4-ratio (r = 0.40, P less than 0.05) but not to levels of serum TSH or free-T4-index or any of the liver function tests in any of the groups. In conclusion, our results do not clearly indicate whether the elevated serum thyroglobulin level in cirrhosis was caused by an impaired elimination and/or an increased secretion from the thyroid gland. The increase in serum thyroglobulin concentration in chronic alcoholic liver disease was not of a magnitude likely to cause misinterpretation of results obtained during the follow-up of patients with differentiated thyroid carcinoma.     

Seroprevalence of antibody against hepatitis C virus (anti-HCV) in various groups of individuals in Korea

We studied the prevalence of anti-HCV in 585 sera from various individuals, using enzyme immunoassay (ElA, Abbott Lab.). Anti-HCV was detected in 16 (10.7%) out of the 150 patients with HBsAg positive liver diseases diagnosed by liver biopsy and they consisted of none out of 10 acute viral hepatitis, 3 out of 15 chronic persistent hepatitis, 4 out of 50 chronic active hepatitis, 2 out of 32 liver cirrhosis, and 7 out of 43 hepatocellular carcinoma. Anti-HCV was detected in 43 (45.3%) out of 95 patients with HBsAg negative liver diseases diagnosed by liver biopsy and they consisted of 5 out of 8 acute viral hepatitis, 2 out of 10 chronic persistent hepatitis, 17 out of 30 chronic active hepatitis, 4 out of 15 liver cirrhosis, and 15 out of 32 hepatocellular carcinoma. Anti-HCV was detected in 22 (38.6%) out of 57 hemodialysis patients, in 3 (6.7%) out of 45 kidney transplants, in 2 (11.1%) out of 18 fatty liver diagnosed by liver biopsy, in 2 (1.3%) out of 150 healthy blood donors, in none out of 40 healthy volunteers, in 6 (31.6%) out of 19 rheumatoid arthritis and in 6 (54.5%) out of 11 systemic lupus erythematosis cases. There were familial clusters of chronic liver diseases in 4.7% of patients with HBsAg negative/anti-HCV positive chronic liver diseases, while in 19.4% of patients with HBsAg positive/anti-HCV negative liver diseases. Incidence of anti-HCV within patients with HBsAg positive liver diseases was higher in HBsAg negative patients than in HBsAg positive patients (17.6% and 10.3%, respectively). In hemodialysis patients, the number of hemodialysis procedures was significantly higher in anti-HCV positive patients than in anti-HCV negative patients (P<0.009), but the amount of blood transfusion showed no difference between anti-HCV positive and negative patients. We concluded that HCV might be an important cause of various types of HBsAg negative liver diseases in Korea, and intrafamilial transmission of HCV might be less common than of hepatitis B virus (HBV), and long duration of hemodialysis might be related to the increment of incidence of anti-HCV in hemodialysis units, and the high frequency of false positive anti-HCV in autoimmune disorders without evidence of any liver diseases might limit the use of the current anti-HCV tests.     

肝细胞癌变过程中维生素E水平改变及其作用机制研究

目的 探讨维生素Ｅ（Ｖｉｔ Ｅ）水平在肝细胞癌变过程中的改变与作用机制。方法 用２－ＦＡＡ制备大鼠肝癌动物模型,在肝细胞癌变过程中观察其肝组织学、肝总ＲＮＡ水平及血浃ＶｉｔＥ含量的动态改变,并对不同肝病患者血清中ＶｉｔＥ的浓度进行了分析。结果 在肝细胞癌变过程中,鼠血清中ＶｉｔＥ含量呈逐渐降低,而鼠肝总ＲＮＡ水平逐渐增加趋势;在急性肝炎、慢性肝炎、肝硬变和肝癌患者血清中ＶｉｔＥ含量均显著低于正常对     

血清蛋白电泳、免疫球蛋白及其轻链测定对肝病患者的临床意义

目的探讨血清中免疫球蛋白和轻链测定以及血清蛋白电泳在肝病患者中的临床应用价值。方法用免疫散射比浊法在特定蛋白分析仪上检测92例肝病患者(包括急性肝炎患者28例、慢性肝炎患者33例、肝硬化患者31例)及45例健康者血清中免疫球蛋白IgG、IgA、IgM以及κ轻链和λ轻链的水平;用琼脂糖凝胶电泳法对所有样本进行血清蛋白电泳检测。结果与对照组相比,急性肝炎组以IgM升高为主,差异有统计学意义(P<0.05);两组κ轻链和λ轻链水平比较,差异无统计学意义(P>0.05)。急性肝炎组和肝硬化组IgG、IgA水平均高于对照组,差异有统计学意义(P<0.05);两组κ轻链和λ轻链水平分别与对照组比较,差异均有统计学意义(P<0.05)。血清蛋白电泳结果显示,急性肝炎组与对照组相比,两组γ区球蛋白含量比较,差异无统计学意义(P>0.05);慢性肝炎组和肝硬化组γ区球蛋白含量与对照组比较,差异有统计学意义(P<0.05)。结论血清中免疫球蛋白及其轻链的含量与肝脏疾病密切相关,慢性肝炎肝硬化患者血清蛋白电泳呈现典型的多克隆增殖图谱。血清蛋白电泳、免疫球蛋白和轻链水平的测定可作为肝脏功能监测的辅助指标。     

High serum adiponectin correlates with advanced liver disease in patients with chronic hepatitis B virus infection

Purpose  Adiponectin possesses anti-inflammatory and insulin-sensitizing properties. Little is known about the role of adiponectin in hepatitis B-related liver disease. Methods  Serum adiponectin and hepatitis B viral factors were cross-sectionally assayed in 280 patients with chronic hepatitis B virus (HBV) infection including 120 patients with chronic HBV infection, 40 patients with cirrhosis, and 120 patients with hepatocellular carcinoma (HCC); 116 healthy adults were used as controls. The dynamics of serum adiponectin level was also studied longitudinally in 25 patients with hepatitis B e antigen (HBeAg) seroconversion (SC). Results  We found that serum adiponectin level in patients with chronic HBV infection was similar to that in healthy controls and was significantly lower than patients with cirrhosis and HCC. In univariate analysis, high serum adiponectin level significantly correlated with the presence of HBV-related cirrhosis or HCC, abnormal serum ALT level, and HBV genotype C. Multivariate analysis revealed that high serum adiponectin level significantly correlated with the development of HCC. Serum adiponectin levels remained stationary in patients experiencing HBeAg SC. Conclusions  Our findings suggest that HBV infection itself does not affect adiponectin levels. Serum adiponectin level correlates with the progression of HBV-related liver diseases but not with the development of HBeAg SC.     

Tenascin expression in human chronic liver disease and in hepatocellular carcinoma.

Tenascin is an oligomeric glycoprotein of the extracellular matrix synthesized during embryonic development. It is prominently expressed in a variety of tumors. The role of tenascin in liver tissue is, however, unknown. We used immunocytochemistry to define the localization of tenascin and compare this with the localization of non-collagenous proteins, such as laminin and fibronectin, in normal human liver and pathological liver from patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. In normal liver, tenascin expression was localized along the sinusoidal and vascular wall. In fibrotic liver, tenascin was also observed in the region between the hepatic parenchyma and the fibrosing portal tracts, especially in areas of piecemeal necrosis in chronic hepatitis. Immuno-EM study of liver tissue in chronic hepatitis strongly suggested the synthesis and secretion of tenascin by fat-storing cells into the space of Disse. In hepatocellular carcinoma, tenascin was expressed in both the capsule and lobular septa, but not in the sinusoidal walls of the tumors. These results led us to postulate a close relationship between the occurrence of this protein and disease processes such as fibrosis and cancer invasion.     

Measurement of serum branched-chain amino acids to tyrosine ratio level is useful in a prediction of a change of serum albumin level in chronic liver disease.

Aim: In patients with hepatitis C virus (HCV)-associated chronic liver diseases, especially in those with liver cirrhosis, accurate evaluation of their protein nutrition status is very important to improve their quality of life. Whereas the serum albumin level is commonly used to evaluate patients' protein nutrition status, in the present study, the serum amino acid levels were measured, as they also provide valuable information. Methods: Serum albumin levels and branched-chain amino acids (BCAA) to tyrosine ratio (BTR) were determined in 447 patients with HCV-associated chronic liver diseases (313 with chronic hepatitis and 134 with liver cirrhosis). Results: Chronic hepatitis progressed to liver cirrhosis, serum albumin and serum BTR levels decreased significantlyas chronic hepatitis progressed to liver cirrhosis. Hypoalbuminemia was significantly more common in patients with liver cirrhosis than in those with chronic hepatitis; however, the incidence of an amino acid imbalance was significantly higher than that of hypoalbuminemia in patients with liver cirrhosis. The presence of an amino acid imbalance was associated with a reduction in the serum albumin level 1 year later. Conclusions: It is important to evaluate serum albumin levels and the BTR in patients with HCV-associated chronic liver diseases.