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投稿时间：2023-07-26 网络发布日期：2023-12-20
投稿时间：2023-07-26 网络发布日期：2023-12-20
中文摘要: 目的 探讨原卟啉Ⅸ（PPⅨ）在肝病发展的不同阶段（肝炎、肝硬化、肝癌）中的临床意义。
方法选择2022年1月至2022年12月就诊于西安医学院第一附属医院41例慢性肝炎患者（肝炎组）、33例肝硬化患者（肝硬化组）、19例肝癌患者（肝癌组），另选同期 40 名健康体检者作为健康对照组。收集各组基础信息、血常规、肝功能、凝血功能、甲胎蛋白（AFP）、乙肝病毒DNA定量（HBV-DNA）、受控衰减参数（CAP）、肝脏硬度值（LSM）、γ-谷氨酰转肽酶/血小板比值（GPR）比较分析各指标与PPⅨ的相关性，进一步分析PPⅨ、肝功能相关指标对肝硬度的预测价值。
结果 肝炎组、肝硬化组、肝癌组与对照组性别、年龄、PPⅨ比较差异有统计学意义（P＜0.05）；肝炎组、肝硬化组、肝癌组的总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、总胆汁酸（TBA）、胆碱酯酶（CHE）、天门冬氨酸转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（γ-GT）、总蛋白（TP）、白蛋白（ALB）、AFP、CAP、LSM、GPR比较差异有统计学意义（P＜0.05）； PPⅨ与AFP、TBIL、DBIL、IBIL、TBA、AST、ALP、LSM、GPR呈正相关（r=0.359，0.350、0.400、0.299、0.238、0.238、0.396、0.235、0.296，P<0.05）；PPⅨ与RBC、HB、PLT、CHE、ALB呈负相关（r＝-0.242、-0.219、-0.261、-0.341、-0.206，P<0.05）。PPⅨ、TBIL、DBIL、ALP对于肝脏硬度的预测有价值，AUC分别为0.623、0.728、0.797、0.660。
结论 肝炎患者PPⅨ水平高于健康人群，可作为早期肝功能损害的预警指标。血清PPⅨ水平与胆汁淤积、肝脏硬度密切相关，其对于慢性肝病进展及预后的临床评价具有重要意义。
Abstract:Objective To investigate the clinical significance of protoporphyrin Ⅸ (PPⅨ) in different stages of liver disease development, including hepatitis, cirrhosis, and liver cancer.
Methods A total of 41 patients with chronic hepatitis (hepatitis group), 33 patients with liver cirrhosis (cirrhosis group), and 19 patients with liver cancer (liver cancer group) who visited the First Affiliated Hospital of Xi'an Medical University from January 2022 to December 2022 were selected as study object. Additionally, 40 healthy examinees during the same period were selected as the health control group. The basic information, blood routine, liver function, coagulation function, alpha fetoprotein (AFP)，controlled attenuation parameter (CAP)，liver stiffness measurement (LSM)，γ-glutamyl transpeptidase to platelet ratio (GPR) from each group were collected and compared. The correlation between various indicators and PPⅨ was analyzed. And the predictive value of PPⅨ and liver function related indicators on liver stiffness was analyzed.
Results There were significant differences in gender, age, and PPⅨ between the hepatitis group, liver cirrhosis group, and liver cancer group compared to the control group (P<0.05). There were significant differences in total bilirubin (TBIL)，direct bilirubin (DBIL)，indirect bilirubin (IBIL)，total bile acid (TBA)，cholinesterase (CHE)，aspartate aminotransferase (AST)，alkaline phosphatase (ALP)，γ-glutamyl transpeptidase (γ-GT)，total protein (TP)，albumin (ALB) AFP, CAP, LSM and GPR between the hepatitis group, liver cirrhosis group, and liver cancer group (P<0.05). PPⅨ was positively correlated with AFP, TBIL, DBIL, IBIL, TBA, AST, ALP, LSM, GPR (r=0.359,0.350, 0.400, 0.299, 0.238, 0.238, 0.396, 0.235, 0.296, P<0.05). PPⅨ was negatively correlated with RBC, HB, PLT, CHE, ALB (r=-0.242, -0.219, -0.261, -0.341, -0.206, P<0.05). PPⅨ (AUC=0.623), TBIL (AUC=0.728), DBIL (AUC=0.797), and ALP (AUC=0.660) were valuable for predicting liver stiffness.
Conclusion The level of PPⅨ in hepatitis patients is higher than that in healthy individuals, which can serve as a warning indicator for early liver function damage. The serum PPⅨ level is closely related to cholestasis and liver hardness, which is of great significance for clinical evaluation of the progression and prognosis of chronic liver disease.
keywords: Chronic hepatitis B Liver cirrhosis Liver cancer Protoporphyrin Ⅸ Cholestasis Liver function damage
文章编号： 中图分类号：R575 R446.1 文献标志码：B
基金项目:陕西省重点研发计划项目（2022SF-577）；陕西省科学技术厅资助项目（2023-YBSF-044）
附件
| 作者 | 单位 |
| 王霞 | 1. 西安医学院第一附属医院全科医学科，陕西 西安 710077 |
| 崔洁 | 1. 西安医学院第一附属医院全科医学科，陕西 西安 710077 |
| 刘咪 | 2. 西安医学院第一附属医院消化内科，陕西 西安 710077 |
| 李伟琴 | 3. 西安医学院第一附属医院儿科，陕西 西安 710077 |
| 刘凯歌 | 4. 西安医学院临床医学院，陕西 西安 710021 |
引用文本：
王霞,崔洁,刘咪,等.原卟啉Ⅸ与肝炎、肝硬化、肝癌的相关性研究[J].中国临床研究,2023,36(12):1847-1851.
王霞,崔洁,刘咪,等.原卟啉Ⅸ与肝炎、肝硬化、肝癌的相关性研究[J].中国临床研究,2023,36(12):1847-1851.