本文關(guān)鍵詞：慢性乙型肝炎患者血清中α1微球蛋白檢測(cè)的臨床意義　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： ɑ1微球蛋白 乙型肝炎 血清學(xué)檢測(cè) 肝功能 乙肝病毒DNA

【摘要】：背景:慢性乙型病毒性肝炎(chronic hepatitis B,CHB)是由乙型肝炎病毒(hepatitis Bvirus,HBV)感染引起的一種傳染性疾病,極易慢性化,并最終演化為肝硬化與肝細(xì)胞癌。全球約有4億人為慢性HBV攜帶者,近30%的世界人口感染或曾經(jīng)感染過(guò)HBV。2006年全國(guó)乙肝流行病學(xué)調(diào)查表明,我國(guó)1~59歲一般人群乙肝病毒攜帶率為7.18%,5歲以下兒童0.96%,現(xiàn)有慢性HBV感染者約9300萬(wàn)人,其中慢性乙肝患者約2000萬(wàn)人。早期發(fā)現(xiàn)病毒性肝炎患者的肝損害程度十分重要,目前檢測(cè)肝臟功能的指標(biāo)很多,但都很難準(zhǔn)確客觀地反映肝臟的功能狀況。α1微球蛋白(alpha 1-microglobulin,α1-MG)為相對(duì)分子質(zhì)量26 000~33 000的小分子糖蛋白,在體內(nèi)分布廣泛,主要由肝細(xì)胞特異性合成后,隨血液運(yùn)輸分配到體內(nèi)各種組織中,具有重要的生理作用。目的:本文通過(guò)檢測(cè)243例CHB患者血清ɑ1-MG的水平,并與其他常用肝功能指標(biāo)進(jìn)行比較,以探討其在CHB患者中檢測(cè)的臨床意義。方法:將243例CHB患者分為肝腎功能正常組、肝功能正常腎功能異常組、肝功能異常腎功能正常組和肝腎功能異常組,同時(shí)選取67名健康體檢者作為對(duì)照組,測(cè)定各組受試者血清ɑ1-MG水平,同時(shí)測(cè)定丙氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、堿性磷酸酶(ALP)等肝功能指標(biāo)及肌酐(CREA)、尿素氮(BUN)等腎功能指標(biāo)。ɑ1-MG檢測(cè)采用免疫比濁法,ALT采用紫外-乳酸脫氫酶法,AST采用紫外-蘋果酸脫氫酶法,ALP采用AMP緩沖液法,CREA采用肌氨酸氧化酶法,BUN采用紫外-谷氨酸脫氫酶法。結(jié)果:與對(duì)照組比較,肝功能異常腎功能正常組患者血清ɑ1-MG水平明顯降低(P0.05),肝腎功能正常組和肝腎功能異常組患者血清ɑ1-MG水平無(wú)明顯變化(P0.05),肝功能正常腎功能異常組患者血清ɑ1-MG水平明顯升高(P0.01)。按照ɑ1-MG10 mg·L-1為判斷肝功能異常的標(biāo)準(zhǔn),肝功能異常腎功能正常組患者血清ɑ1-MG陽(yáng)性率為36%,肝腎功能異常組患者血清ɑ1-MG陽(yáng)性率為24%;如以ɑ1-MG15 mg·L-1為標(biāo)準(zhǔn),則肝功能異常腎功能正常組患者血清ɑ1-MG陽(yáng)性率為68%。肝功能異常腎功能正常組患者血清ɑ1-MG水平與肝功能指標(biāo)ALT、AST及ALP呈負(fù)相關(guān)關(guān)系(r=-0.934,r=-0.916,r=-0.847,P0.01),且其數(shù)值隨著肝損傷程度的加重而降低。結(jié)論:肝腎功能正常的CHB患者血清ɑ1-MG水平略低于正常對(duì)照組,但與對(duì)照組無(wú)顯著差異;肝功能正常腎功能異常組患者血清ɑ1-MG水平高于正常對(duì)照組,即腎功能損害時(shí)血清ɑ1-MG增高;肝功能異常時(shí),CHB患者血清ɑ1-MG的水平根據(jù)腎功能是否異常而不同。如合并腎功能異常,則ɑ1-MG的水平與對(duì)照組比較無(wú)顯著差別;如腎功能正常,則ɑ1-MG水平顯著降低;ɑ1-MG與ALT及AST呈顯著負(fù)相關(guān)。以ɑ1-MG15 mg·L-1為判斷肝功能異常的標(biāo)準(zhǔn),單純肝功能異常時(shí)的陽(yáng)性率為68%,ɑ1-MG是檢測(cè)CHB患者肝功能的一個(gè)有效的指標(biāo),但臨床上應(yīng)用時(shí)須排除腎功能損害引起的結(jié)果干擾。HBV DNA低載量組及HBV DNA高載量組ɑ1-MG水平差異不顯著,ɑ1-MG水平似乎和肝炎病毒感染無(wú)直接關(guān)系。
[Abstract]:Background: chronic hepatitis B (chronic hepatitis, B, CHB) is caused by the hepatitis B virus (hepatitis Bvirus HBV) is a contagious disease caused by infection, easily lead to chronic infection, and eventually evolved into liver cirrhosis and hepatocellular carcinoma. There are about 400 million people with chronic HBV carriers worldwide, nearly 30% of the world's population is infected have been infected with HBV.2006 or hepatitis B national epidemiological survey shows that China's general population aged 1~59 of hepatitis B virus carrying rate was 7.18%, 0.96% children under the age of 5, the existing chronic HBV infection about 93 million people, of which about 20 million of patients with chronic hepatitis B. Early detection of the severity of liver damage in patients with viral hepatitis is very important, at present a lot of detection the liver function index, but it is difficult to accurately and objectively reflect the functional status of the liver. Alpha 1 microglobulin (alpha 1-microglobulin, alpha 1-MG) for a relatively small molecule glycoprotein molecular mass of 26 000~33 000, Widely distributed in the body, mainly by the liver cell specific synthesis, transportation and distribution of blood into the body with a variety of organizations, plays an important physiological role. Objective: in this paper, by measuring the level of serum of 243 cases of patients with CHB. 1-MG, and compared with other commonly used indicators of liver function, and to evaluate its clinical significance in detection of CHB patients the. Methods: 243 cases of CHB patients were divided into normal group, liver and kidney function, normal liver function abnormal renal function group, normal group and liver function abnormal renal function abnormal liver function group, and 67 healthy persons were selected as control group, serum alpha 1-MG levels measured for each group of subjects, the simultaneous determination of alanine aminotransferase transferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and other indexes of liver function and serum creatinine (CREA), urea nitrogen (BUN) and other indexes of renal function. Alpha 1-MG was detected by immune turbidimetry, ALT UV - lactic acid dehydration Hydrogen enzyme method, AST UV - malate dehydrogenase, ALP using AMP buffer method, CREA using sarcosine oxidase method, BUN UV - glutamic acid dehydrogenase method. Results: compared with the control group, abnormal renal function in patients with normal liver function group. Serum 1-MG levels were significantly lower (P0.05), liver and kidney the function of normal and abnormal function of the liver and kidney. The serum 1-MG level in patients with no significant change (P0.05), normal renal function in patients with abnormal liver function group. Serum 1-MG levels were significantly increased (P0.01). According to the 1-MG10 mg alpha L-1 for judging the abnormal liver function, abnormal liver function in normal renal function group in serum of patients with 1-MG positive. The rate is 36%, liver and kidney dysfunction group positive rate of serum alpha 1-MG 24%; alpha 1-MG15 mg, such as L-1 standard, then the abnormal renal function normal liver function group positive rate of serum alpha 1-MG abnormal renal function of 68%. patients with normal liver function serum alpha 1-MG water Flat and ALT of liver function index, a negative correlation between AST and ALP (r=-0.934, r=-0.916, r=-0.847, P0.01), and its value with the severity of liver injury decreased. Conclusion: normal liver and kidney function in patients with CHB serum alpha 1-MG level is slightly lower than the normal control group, but no significant difference with the control group; normal kidney the function of the abnormal liver function group. Serum levels of 1-MG were higher than the normal control group, the impairment of renal function serum alpha 1-MG increased; the abnormal liver function, serum CHB level in patients with 1-MG. According to whether the abnormal renal function and different. If combined with abnormal renal function, while the level of 1-MG. Compared with the control group have no significant difference; such as normal renal function, then investigate the level of 1-MG decreased significantly; alpha 1-MG was negatively correlated with ALT and AST. 1-MG15. Mg to L-1 for judging the abnormal liver function standard, the positive rate of abnormal liver function in simple 68%, alpha 1-MG is detected the liver function in patients with CHB An effective index, but the clinical application to exclude renal dysfunction caused by the interference of.HBV DNA low load group and HBV DNA high level of 1-MG group. No significant difference between 1-MG and alpha level of hepatitis B virus infection seems to have no direct relationship.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62

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