【作者】 刘芬；

【导师】 童巧霞； 翁志宏；

【作者基本信息】 华中科技大学 ， 内科学（感染病学）， 2018， 硕士

【摘要】 目的:肝脏损伤时同型半胱氨酸(Hcy)代谢障碍,形成高同型半胱氨酸血症(h Hcy),通过氧化应激导致细胞损伤,加速肝脏疾病恶化。在本研究中,我们旨在探讨Hcy浓度与乙型病毒性肝炎肝硬化之间的相关性,为乙型病毒性肝炎肝硬化的预后以及防治提供新的思路。方法:在横断面回顾性研究中,我们分析了2015年6月至2017年8月期间共474例因乙肝肝硬化住院的患者,并记录下血浆同型半胱氨酸(Hcy)水平以及患者基本资料及临床数据,计算出MELD和Child-Pugh分数以及肝硬化并发症(腹水、肝性脑病、食管胃静脉曲张破裂出血)发生率:通过线性回归分析确定Hcy与终末期肝病模型(MELD)之间的相关性,通过Pearson相关系数(r)分析确定肝硬化并发症与Hcy和MELD评分、以及Hcy与Child-Pugh得分之间的相关性。结果:对474例研究人群的血浆Hcy水平进行四分位划分后,与Hcy第一分位相比,第四分位的年龄更大、男性比例更高,饮酒比例更高,以及个体中高血压、肾病患病率更高,且有统计学意义;乙肝肝硬化中高Hcy与更高的ALT、CR、PT、INR、MELD评分、Child-pugh评分以及更高的腹水、食管胃静脉曲张出血、肝性脑病发生率有关系,且有统计学意义。在线性回归中,在未校正任何变量的情况下,研究发现,随着Hcy分位增加,终末期肝病评分增加,且趋势性检验有统计学意义;连续型变量发现Hcy每增加一个单位(1mmol/l),终末期肝病评分增加8.148个单位,且有统计学意义。在校正年龄性别以及年龄、性别、饮酒史、ALT、ALB、PT、LDLC的情况下,随着Hcy分位增加,MELD评分增加,且趋势性检验有统计学意义。血浆Hcy与Child-pugh评分相关系数r=0.0075,p=0.0087小于0.01,有统计学意义。在肝硬化并发症与Hcy关系中,腹水与Hcy的相关系数r=0.1300,p=0.0046小于0.05,有统计学意义,食管胃静脉曲张破裂出血与Hcy的相关系数r=0.1173,p=0.0108小于0.05,有统计学意义,肝性脑病与Hcy的相关系数r=0.2615,p小于0.0001,有统计学意义,肝硬化并发症与终末期肝病评分关系;腹水与MELD的相关系数r=0.2947,p小于0.001,有统计学意义,食管胃静脉曲张破裂出血与MELD的相关系数r=0.2083,p小于0.001,有统计学意义,肝性脑病与MELD的相关系数r=0.2484,p小于0.0001,有统计学意义。结论:在横断面研究,在中老年人群中血浆Hcy与乙型病毒性肝炎肝硬化严重程度呈正相关。更多还原

【Abstract】 Objective:The damages of the liver induce the disorders of homocysteine(Hcy)metabolism and hyperhomocysteinemia(h Hcy).Moreover,Hcy accelerates the progression of liver disease by oxidative stress,resulting in cell damage.In this study,we aimed to investigate the relationship between plasma homocysteine concentration and Hepatitis B cirrhosis and provide new ideas for the prognosis and prevention of Hepatitis B cirrhosis.Methods: In a cross-sectional retrospective study,we analyzed a total of 474 hospitalized patients for Hepatitis B cirrhosis from June 2015 to August 2017.We also recorded Hcy levels,patients’ basic data and clinical data to calculate the scores of MELD and Child-Pugh.The incidence of cirrhosis complications(ascites,hepatic encephalopathy,esophageal and gastric variceal bleeding)is also recorded.By linear regression analysis,we determined the correlation between Hcy and MELD.By Spearman correlation(r)analysis,we determined the correlations between the complications of cirrhosis and other two factors,including Hcy and scores of MELD.We also determined the correlations between Hcy and the scores of Child-Pugh.Results: After quartering the plasma Hcy levels of the study population,we founded the fourth quartile was older and had a higher proportion of males and the history of drinking.The prevalence of hypertension and kidney disease was higher,with statistically significance.The plasma Hcy in hepatitis B cirrhosis was associated with higher ALT,CR,PT,INR,MELD score,Child-pugh score,and higher incidence of ascites,esophageal gastric varices bleeding,and hepatic encephalopathy.In linear regression,without correcting any variables,the study found that as the Hcy quintile increased,the MELD score increased,and the trend test was statistically significant(p<0.0001).Continuous variables found Hcy per One unit(1 mmol/l)was added and the MELD score was increased by 8.148 units,which was statistically significant.When the age and sex or age,sex,drinking,ALT,ALB,PT,LDLC were corrected,the study found that with the increase of Hcy quintile,the MELD score increased,and the trend test was statistically significant(p<0.0001).The plasma levels of Hcy were significantly correlated with the scores of Child pugh(Pearson’s r=0.0075,p=0.0087).The plasma levels of Hcy were significantly correlated with complications of liver cirrhosis,such as ascites(Pearson’s r=0.1300,p=0.0046),esophageal gastric varices bleeding(Pearson’s r=0.1173,p=0.0108),hepatic encephalopathy(Pearson’s r = 0.2615,p < 0.0001),which was statistically significant.Similarly,circulating score of MELD displayed a positive correlation with cirrhosis complications such as ascites(Spearman’s r=0.2947,p<0.001),esophageal gastric varices bleeding(Pearson’s r=0.2947,p<0.001),r=0.2084,p<0.001),hepatic encephalopathy(Pearson’s r = 0.2484,p <0.0001),whichwas statistically significant.Conclusions: In the cross-sectional study,in the middle-aged and elderly population plasma Hcy was positively correlated with the severity of Hepatitis B cirrhosis.更多还原