【作者】 张帆；

【导师】 彭志海；

【作者基本信息】 上海交通大学 ， 外科学， 2014， 博士

【摘要】 补体系统参与机体免疫反应，其成分80%在肝脏中合成，如肝细胞被破坏，则补体生成减少。肝胆外科主要以手术方法治疗肝内胆管结石、肝细胞癌、肝炎后肝硬化和重型肝炎所致的急慢性肝功能衰竭等疾病，补体系统可能参与这些疾病的发病机制。因此，检测肝脏疾病患者的血清补体水平，具有重要的临床意义。研究目的通过收集分析我院肝胆外科近些年诊治的86例肝脏疾病患者的相关临床资料，探讨血清补体水平的检测对原发性肝癌、乙肝后肝硬化等疾病的评估、预后的临床意义。方法统计2012年1月1日至2013年12月31日间，上海交通大学附属第一人民医院肝胆外科收治患者住院期间血清补体水平、血常规、肝肾功能、凝血常规、AFP数值等血清检查结果，以及B超、CT等影像学结果。有条件行手术治疗的患者，术后定期检测血清补体水平、血常规、肝肾功能、凝血全套等，同时记录术后病理分级。将病例筛选入组后，收集以上检验结果，结合患者年龄、性别等影响因素进行统计学分析。结果（1）血清补体水平与肝脏疾病患者性别、年龄无明显相关性。（2）血清补体水平与血液凝血状态相互影响，并一定程度上反应肝脏合成功能好坏。与正常对照组相比，肝脏疾病患者血清C3、C4、CH50均下降：其中肝硬化患者下降幅度较为明显，而肝癌患者下降幅度相对减小，且血清补体水平与AFP、CEA、CA199等肿瘤标记物无明显相关性。（3）血清补体水平对慢性乙型肝炎患者肝炎活动度的病理学分级、肝纤维化的病理学分期、肝癌肿瘤病理类型与分化程度等有一定的判别意义。（4）肝脏手术方式影响肝癌患者术后血清补体水平恢复过程。原位肝移植术后患者C3、C4、CH50上升延迟于肝切除手术患者。原位肝移植术后患者血清补体水平恢复过程与术前肝功能状态无关。结论血清补体水平的检测对评估原发性肝癌、乙肝后肝硬化等肝脏疾病患者的病情、转归、预后等均具有一定的临床意义。更多还原

【Abstract】 The complement system plays an important role in the immune response,while80%of it is synthesized in the liver. The production of complementwill decrease if the liver cells are destroyed. Hepatobiliary surgery ismainly in surgical treatment of hepatocellular carcinoma, intrahepatic bileduct stones, liver cirrhosis and severe hepatitis due to acute or chronicliver failure and other diseases, and the complement system may beinvolved in the pathogenesis of these diseases. Therefore, it has importantclinical significance to determinate the serum complement levels inpatients with liver diseases.ObjectiveTo investigate the clinical significance of the serum complement levels todetection or evaluation of the primary liver cancer, liver cirrhosis andother liver diseases, by collecting and analyzing the relevant clinical dataof86cases who are treated in Hepatobiliary Surgery of our hospital inrecent years and are enrolled into the groups. MethodsCheck the serum complement levels, blood, liver and kidney function,blood clotting routine, AFP values and so on of the patients duringhospitalization, who were treated in Hepatobiliary Surgery of ShanghaiFirst People’s Hospital from January1,2012to December31,2013. Getthe results of their B ultrasound, CT and other imaging inspection. Checkthe serum complement levels, blood, liver and kidney function, bloodclotting routine after the surgery when conditions permitting. Record thepathological grading. Then collect all results to do a statistical analysiscombined with factors of age, gender and so on.Results(1) The serum complement levels in patients with liver disease, has nosignificant correlation with the gender or age.(2) The serum complement levels and blood clotting status interact witheach other. It probably reflects the liver synthetic function. Comparedwith normal control group, the serum C3, C4, CH50of patients with liverdiseases decreased, especially in patients with liver cirrhosis. The levelsdecrease less in C4and patients with liver cancer, and it has nosignificant correlation with AFP, CEA and CA199(3) The levels of serum complement have a certain degree ofdiscrimination significance with the pathology of chronic hepatitis B patients in hepatitis activity grading, pathological staging of liver fibrosis,liver tumor histological type and differentiation.(4) The surgery impacts the levels’ recovery process of serumcomplement in patients with hepatocellular carcinoma after surgery.Compared with patients with liver resection, the levels of C3, C4, CH50of patients with orthotopic liver transplantation delayed. The recovery oflevels of serum complement has no correlation with the status of liverfunction before orthotopic liver transplantation in patients with livercancer.ConclusionIt has had some clinical significance of serum complement levels to theassessment of prognosis, outcome and so on of patients with primary livercancer, liver cirrhosis and other liver diseases.更多还原