慢性乙型肝炎患者血清α1微球蛋白检测的临床意义

doi:10.13481/j.1671-587x.20170119

摘要/Abstract

摘要：

目的：检测不同肝功能损伤情况下慢性乙型肝炎（CHB）患者血清α1微球蛋白（α1-MG）的水平，探讨采用α1-MG评价CHB患者肝功能的临床意义。方法：243例CHB患者分为肝肾功能正常组（n=94）、肝功能正常肾功能异常组（n=20）、肝功能异常肾功能正常组（n=100）和肝肾功能异常组（n=29），同时选取健康体检者67人作为对照组，测定各组受试者血清α1-MG水平，同时测定谷氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和碱性磷酸酶（ALP）等肝功能指标及血清肌酐（CREA）、尿素氮（BUN）等肾功能指标。采用免疫比浊法检测α1-MG水平，采用紫外-乳酸脱氢酶法检测ALT水平，采用紫外-苹果酸脱氢酶法检测AST水平，采用AMP缓冲液法检测ALP水平，采用肌氨酸氧化酶法检测CREA水平，采用紫外-谷氨酸脱氢酶法检测BUN水平。结果：与对照组比较，肝功能异常肾功能正常组患者血清α1-MG水平明显降低（P<0.05），肝肾功能正常组和肝肾功能异常组患者血清α1-MG水平无明显变化（P>0.05），肝功能正常肾功能异常组患者血清α1-MG水平明显升高（P<0.01）。按照α1-MG<10 mg·L^-1为判断肝功能异常的标准，肝功能异常肾功能正常组患者血清ɑ1-MG阳性率为36%，肝肾功能异常组患者血清α1-MG阳性率为24%；如以α1-MG<15 mg·L^-1为标准，则肝功能异常肾功能正常组患者血清α1-MG阳性率为68%。肝功能异常肾功能正常组患者血清α1-MG水平与肝功能指标ALT、AST和ALP呈负相关关系（r=-0.934，r=-0.916，r=-0.847，P<0.01），且其数值随着肝损伤程度的加重而降低。结论：α1-MG检测在判断CHB患者肝功能方面具有一定的临床意义，但须排除肾功能损害引起的结果干扰。

关键词: 肝炎, 血清学检测, 肝功能, ɑ1微球蛋白, 肾功能, 乙型

Abstract:

Objective: To explore clinical significance of alpha 1 microglobulin (α1-MG) in the evaluation on liver function in the patients with chronic hepatitis B (CHB) through detecting the serum levels of α1-MG in the CHB patients with different liver function injuries.Methods: Total 243 CHB patients were divided into normal liver and renal function group(n=94),normal liver function and abnormal renal function group(n=20),abnormal liver function and normal renal function group(n=100),abnormal liver and renal function group(n=29),while 67 cases of healthy persons were selected as control group.The serum α1-MG levels of the subjects in various groups were measured by immune turbidimetry; the liver function indexes such as alanine aminotransferase (ALT),aspartate transaminase (AST), alkaline phosphatase (ALP),and the renal function indexes such as creatinine (CREA),blood urea nitrogen (BUN) were determinedby ultraviolet lactate dehydrogenase method,UV-malate dehydrogenase method,AMP buffer method,sarcosine oxidase method, and UV-glutamic acid dehydrogenase method.Results: Compared with control group,the level of α1-MG in serum of the patients in abnormal liver function and nomal renal function group was significantly decreased (P<0.05),the serum α1-MG levels of the patients in normal liver function and renal function group and abnormal liver and renal function group had no significant changes (P>0.05),and the serum α1-MG level of the patients in normal liver function and abnormal renal function group was significantly increased (P<0.01).According to α1-MG <10 mg·L^-1 as the standard for judging abnormal liver function,the positive rate of α1-MG in the patients in abnormal liver function and normal renal function group was 36% and the positive rate in abnormal liver and renal function group was 24%.As to α1-MG <15 mg·L^-1 as the standard,the positive rate of α1-MG in abnormal liver function and normal renal function group was 68%.The serum α1-MG level had negatively correlated with the ALT,AST and ALP of the patients in abnormal liver function and nomal renal function group (r=-0.934,r=-0.916,r=-0.847,P<0.01),and its values were decreased with the severity of liver injury.Conclusion: α1-MG detection has certain clinical significance in judging liver function in the patients with CHB,but it is necessary to exclude the interference caused by renal damage.

Key words: alpha 1-microglobulin, serological detection, liver function, renal function, hepatitis B

中图分类号:

R446.11

魏雁虹, 宋帅, 耿辉, 刁斌斌, 杨广民. 慢性乙型肝炎患者血清α1微球蛋白检测的临床意义[J]. 吉林大学学报(医学版), 2017, 43(01): 96-100.

WEI Yanhong, SONG Shuai, GENG Hui, DIAO Binbin, YANG Guangmin. Clinical significance of detection of alpha 1-microglobulin in serum of patients with chronic hepatitis B[J]. Journal of Jilin University Medicine Edition, 2017, 43(01): 96-100.

参考文献

[1] Trépo C,Chan HL,Lok A. Hepatitis B virus infection[J].Lancet,2014,384(9959):2053-2063.
[2] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].中华肝脏病杂志,2015,23(12):888-905.
[3] 位松华.α1-微球蛋白检测对于糖尿病肾病早期诊断的临床价值分析[J].中国实验诊断学,2015,19(6):1001-1003.
[4] 黄景明,徐朝阳,史煜波,等.血正五聚蛋白3、尿α1微球蛋白与免疫球蛋白G对糖尿病肾病早期诊断的价值[J].实验与检验医学,2013,31(03):211-213,216.
[5] 向代军,张洪瑞,白洁,等.尿α1微球蛋白和β2微球蛋白对2~4期慢性肾病患者的诊断价值[J].检验医学与临床,2014,11(8):1011-1012,1015.
[6] Stubendorff B,Finke S,Walter M,et al.Urine protein profiling identified alpha-1-microglobulin and haptoglobin as biomarkers for early diagnosis of acute allograft rejection following kidney transplantation[J].World J Urol,2014,32(6):1619-1624.
[7] Edström-Hägerwall A,Hansson S,Casslén V,et al.PP010.Alpha-1-microglobulin protects from heme induced placenta and kidney damage in a pregnant ewe model for preeclampsia[J].Pregnancy Hypertens,2013,3(2):70-71.
[8] Mariona FG,Roura LC.The role of placental alpha microglobulin-1 amnisure in determining the status of the fetal membranes;its association with preterm birth[J].J Matern Fetal Neonatal Med,2016,29(6):1016-1020.
[9] Nikolova T,Bayev O,Nikolova N,et al.Comparison of a novel test for placental alpha microglobulin-1 with fetal fibronectin and cervical length measurement for the prediction of imminent spontaneous preterm delivery in patients with threatened preterm labor[J].J Perinat Med,2015,43(4):395-402.
[10] Vyssoulis GP,Tousoulis D,Antoniades C,et al.Alpha-1 microglobulin as a new inflammatory marker in newly diagnosed hypertensive patients[J].Am J Hypertens,2007,20(9):1016-1021.
[11] 王中兴,覃文珍,朱小琼.血清α1-MG、β2-MG在慢性肝病中的变化[J].临床荟萃,2002,17(2):104-105.
[12] 孙世炳.α-微球蛋白在临床检验中的应用[J].国外医学:临床生物化学与检验学分册,1990,11(4):35-36.
[13] Shore N,Khurshid R,Saleem M.Alpha-1 microglobulin:a marker for early detection of tubular disorders in diabetic nephropathy[J].J Ayub Med Coll Abbottabad,2010,22(4):53-55.
[14] 周霞秋.各种肝病时的人α1-微球蛋白研究[J].国外医学:内科学分册,1984(4):208.
[15] 李阳,咸建春.慢性乙型肝炎患者血清HBV外膜大蛋白、HBsAg、HBVDNA及ALT水平与肝组织炎症活动度的相关性[J].临床肝胆病杂志,2015,31(12):2054-2056.
[16] 覃小梅,范宸颖,李双杰,等.慢性乙型肝炎患儿HBVDNA载量与肝脏病理、肝功能、肝纤维化血清学指标的相关性分析[J].临床肝胆病杂志,2016,32(3):472