血清PAB、CHE、TBA和ALT的含量变化与肝炎病理分级的关系探讨

目的:探讨慢性乙型病毒性肝炎(乙肝)患者血清前白蛋白(PAB)、胆碱酯酶(CHE)、总胆汁酸(TBA)及丙氨酸氨基转移酶(ALT)水平的变化及其与肝脏炎症分级及纤维化分期之间的相关性。方法:观察93例经肝活检证实的慢性乙肝患者血清PAB、CHE、TBA及ALT水平的变化,并将其与肝活检组织的炎症分级和纤维化分期进行相关性分析。结果:肝脏病理组织炎症分为G1～G4级,纤维化分为S0～S4期。炎症轻重两组间PAB、CHE、TBA及ALT均有显著性差异(P<0.01)。随着纤维化程度的增加,ALT变化无规律,PAB、CHE逐渐下降,而TBA逐渐升高,且S4及S0、S1、S2和S3比较有显著性差异(P<0.01)。PAB、CHE、TBA及ALT与炎症分级之间,CHE、TBA和PAB与纤维化分期之间,相关性均非常显著(P均<0.01)。结论:PAB、CHE、TBA及ALT能较好地反映慢性乙肝肝脏的炎症活动水平,CHE、TBA和PAB能较敏感地反映慢性乙肝肝脏的纤维化程度;四个指标在一定程度上可以提示早期肝硬化。

Changes of Serum Levels of Prealbumin (PAB), Cholinesterase (CHE),Total Bile Acid (TBA) and ALT as Related to the Severity of Inflammatory Process and Hepatic Fibrosis in Patients with Chronic Virus B Hepatitis

Objective To study the correlationship between the serum levels of PAB,CHE,TBA,ALT and the severity of the disease process in patients with chronic virus B hepatitis. Methods Serum levels of PAB,CHE,ALT (with biochemical methods) and TBA (with RIA) were examined in 93 patients with biopsy proven virus B hepatitis and 46 controls. Results The 93 patients were of two groups: a less advanced group (n=51) and a more advanced group (n=42). Serum TBA,ALT levels were significnatly higher and serum PAB,CHE levels were significantly lower in the more advanced group than those in the less advanced group (P<0.01). Severity of fibrosis was graded from s_0 to s_4. Changes of levels of ALT were of no regular pattern, but serum levels of TBA regularly increased and levels of PAB,CHE regularly decreased as the fibrosis grading proceeded from s_0 to s_4 and the differences between the levels in s_4 and any other grading were significant (P<0.01). Conclusion Combined determination of these serum markers might reflect the degree of inflammatory process and hepatic fibrosis in patients with virus B hepatitis, leading to earlier detection of cirrhosis.