Effect of different homocysteine levels on the prognosis of patients with hepatitis B liver cirrhosis
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摘要: [目的]分析不同同型半胱氨酸（Hcy）水平对乙肝肝硬化患者预后的影响。[方法]纳入2014年1月~2015年1月我院收诊的119例乙肝肝硬化患者作为研究资料进行分析，以1年内发生的不良事件为判断预后的标准。将119例患者血清Hcy水平与肝功能Child-Pugh得分进行Pearson相关分析，得出两者的关系，再根据不同肝功能Child-Pugh等级将患者分为Hcy水平不同的3组，分析不同Hcy水平患者肝功能指标谷丙转氨酶（ALT）、总胆红素（TBiL）和肝纤维化指标III型前胶原（PCⅢ）、IV型胶原（IV-C）的关系，分析Hcy对肝功能和肝纤维化的影响，观察1年期内3组不同Hcy水平患者发生不良事件的比例，探讨Hcy水平对患者不良事件的影响。[结果]患者血清Hcy水平和肝功能Child-Pugh得分呈正相关（P<0.05）。Child-Pugh C级患者血清ALT、TBiL、PCⅢ和IV-C水平分别为（90.73±1.63 U/L、59.42±1.49 μmol/L、201.48±14.83 ng/ml和284.52±15.88 ng/ml），均高于Child-Pugh B级患者（65.02±1.52 U/L、38.71±1.22 μmol/L、170.39±13.40 ng/ml和261.48±15.73 ng/ml）（均P<0.05），Child-Pugh B级患者以上指标水平均高于Child-Pugh A级患者（46.23±1.40 U/L、27.51±1.60 μmol/L、149.25±12.04 ng/ml和238.51±13.39 ng/ml）（均P<0.05），Hcy水平越高，肝功能越差和肝纤维化越严重。一年内Hcy高水平组患者发展为肝癌比例、肝性脑病比例、肝肾综合征比例、上消化道出血发生比例、发生腹水比例分别为（12.50%、17.50%、20.00%、17.50%、25.00%），均高于Hcy中等水平组（2.22%、4.44%、6.67%、4.44%、6.67%）（均P<0.05）和Hcy低水平组（0、0、3.03%、0、3.03%），Hcy高水平组有2例患者死亡，其他2组无死亡病例，在以上不良事件发生比例上，Hcy低水平组和Hcy中等水平组差异无统计学意义。[结论]肝功能Child-Pugh评分越高，患者血清Hcy水平越高，随着血清Hcy水平的升高，患者肝功能越差、肝纤维化越严重，进而影响患者预后情况。Abstract: [Objective] To observe the effect of different homocysteine levels on the prognosis of patients with hepatitis B liver cirrhosis.[Methods] A total of 119 hepatitis B cirrhosis patients who were admitted to our hospital from January 2014-January 2015 were used as research data to analyze.Adverse events occurred within 1 year were the criteria for prognosis.Pearson correlation was used to analyze the serum Hcy level and Child-Pugh score in 119 patients.Then according to different levels of Child-Pugh liver function, they were divided into three groups of patients with different levels of Hcy to analyze the relationship between alanine aminotransferase(ALT), total bilirubin(TBiL), type III procollagen(PC III) and type IV Collagen(IV-C) with different homocysteine levels.The effects of Hcy on liver function and hepatic fibrosis were analyzed.The incidence of adverse events was observed in three groups of patients with different levels of Hcy during the 1-year period to investigate the effect of Hcy on adverse events.[Results] There was a positive correlation between serum Hcy level and Child-Pugh score(P<0.05).Serum ALT, TBiL, PCⅢ and IV-C level of Child-PughC were(90.73±1.63 U/L, 59.42±1.49μmol/L, 201.48±14.83 ng/ml and 284.52±15.88 ng/ml), which were higher than Child-PughB group with(65.02±1.52 U/L, 38.71±1.22μmol/L, 170.39±13.40 ng/ml and 261.48±15.73 ng/ml) (all P<0.05).Indicator level of Child-PughB group were higher than Child-PughA group with(46.23±1.40 U/L, 27.51±1.60μmol/L, 149.25±12.04 ng/ml and 238.51±13.39 ng/ml) (all P<0.05).The higher the Hcy level, the worse the liver function and the more severe liver fibrosis.The proportion of liver cancer, hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal bleeding and ascites of Hcy high level group were(12.50%, 17.50%, 20.00%, 17.50%, 25.00%), which were higher than Hcy medium level group with(2.22%, 4.44%, 6.67%, 4.44%, 6.67%) (all P<0.05) and Hcy low level group with(0, 0, 3.03%, 0, 3.03%).Two patients died in the high-dose Hcy group, the other two groups had no deaths and there was no significant difference between Hcy low-level group and Hcy medium level group.[Conclusion] The higher the Child-Pugh score, the higher the serum Hcy level.With the increase of serum Hcy levels, the worse the liver function of patients, the more severe liver fibrosis, thus affecting the prognosis of patients.
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Key words:
- homocysteine /
- Hepatitis B virus /
- liver cirrhosis /
- liver function /
- liver fibrosis
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[1] Peng C Y, Chien R N, Liaw Y F.Hepatitis B virus-related decompensated liver cirrhosis:benefits of antiviral therapy[J].J Hepatol, 2012, 57:442-450.
[2] Wong G L, Chan H L, Mak C W, et al.Entecavir treatment reduces hepatic events and deaths in chronic Hepatitis B patients with liver cirrhosis[J].Hepatology, 2013, 58:1537-1547.
[3] Bedossa P.Reversibility of hepatitis B virus cirrhosis after therapy:who and why[J]?Liver Int, 2015, 35(supplement):78-81.
[4] 洪永孟, 郭亚兵.失代偿期乙肝肝硬化患者预后相关因素研究[J].现代消化及介入诊疗, 2012, 17(3):159-161.
[5] Ventura P, Venturelli G, Marcacci M, et al.Hyperhomocysteinemia and MTHFR C677 Tpolymorphism in patients with portal vein thrombosis complicating liver cirrhosis[J].Thromb Res, 2016, 141:189-195.
[6] 周英, 贺平, 苏江.同型半胱氨酸在心血管疾病发病风险及发病机制中的作用研究进展[J].河北医学, 2014, 20(2):346-348.
[7] 肖健, 熊怀民, 钱建平, 等.血清同型半胱氨酸在肝炎、肝硬化及肝癌中的诊断价值研究[J].中国卫生检验杂志, 2015, 16(14):2315-2318.
[8] 中华医学会传染病与寄生虫病学分会, 肝病学分会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 40(6):62-68.
[9] 中国中西医结合学会消化系统疾病专业委员会.肝硬化中西医结合诊治方案[J].现代消化及介入诊疗, 2005, 10(2):119-121.
[10] 王国华, 朱瑞龙.肝硬化难治性腹水和肝肾综合征的定义和诊断标准[J].国际消化病杂志, 1996, 8(4):197-199.
[11] 王世鑫.上消化道出血的诊断标准与治疗方案[J].中国临床医生, 1999, 11(9):23-24.
[12] 李海军, 郭志梅, 杨新英, 等.长期抗病毒治疗对乙型肝炎肝硬化失代偿期患者生存率的影响[J].国际流行病学传染病学杂志, 2016, 43(4):153-155.
[13] 庄焱, 谢青.乙型肝炎肝硬化抗病毒治疗的新观点[J].中华消化杂志, 2012, 32(8):567-570.
[14] Kim C H, Um S H, Seo Y S, et al.Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t) ide analog antiviral agents[J].J Gastroenterol Hepatol, 2012, 27:1589-1595.
[15] 吕娜, 赖新华, 彭福江.血清同型半胱氨酸浓度变化与乙型肝炎病毒相关性肝脏疾病关系研究.医学检验与临床, 2013, 5(3):104-106.
[16] Wada M, Kuroki M, Minami Y, et al.Quantitation of sulfur-containing amino acids, homocysteine, methionine and cysteine in dried blood spot from newborn baby by HPLC-fluorescence detection[J].Biomed Chromatogr, 2014, 28:810-814.
[17] 郭平, 黄鑽, 黄杰, 等.乙型肝炎患者氨基酸代谢与同型半胱氨酸浓度变化分析[J].昆明医科大学学报, 2011, 32(8):62-65.
[18] MládkováJ, Vaněk V, Budě2ínský M, et al.Doubleheaded sulfur-linked amino acids as first inhibitors for betaine-homocysteine S-methyltransferase 2[J].J Med Chem, 2012, 55:6822-6831.
[19] 门莎莎, 田亚平, 董振南.同型半胱氨酸在肝脏疾病中的诊断价值[J].解放军医学院学报, 2011, 32(4):325-326.
[20] Choudhury S, Borah A.Activation of NMDA receptor by elevated homocysteine in chronic liver disease contributes to encephalopathy[J].Med Hypotheses, 2015, 85:64-67.
[21] 焦晓磊, 高英堂, 景丽, 等.血清同型半胱氨酸、叶酸、亚甲基四氢叶酸还原酶与HBV感染后疾病进展关系的研究[J].生物医学工程与临床, 2013, 9(6):595-600.
[22] 王艾, 谭博, 张爱玲, 等.同型半胱氨酸对脑梗死患者血管内皮细胞功能的影响[J].检验医学与临床, 2015, 3(1):121-123.
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