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目的分析不同进展阶段乙型肝炎病毒(HBV)感染者血清中同型半胱氨酸(HCY)、叶酸和亚甲基四氢叶酸还原酶(MTHFR)的水平、相关性及其与肝病进展的关系。方法按照性别、年龄和基因型均匹配的原则挑选乙型肝炎自愈组(男性15例,女性15例;年龄37~66岁,平均年龄52.90岁)、肝硬化组(男性15例,女性15例;年龄36~73岁,平均年龄54.87岁)和肝癌组(男性15例,女性15例;年龄38~78岁,平均年龄56.37岁)研究对象各30例,采用酶联免疫吸附分析(ELISA)检测试剂盒检测血清HCY、MTHFR和叶酸的水平。结果血清叶酸和MTHFR水平在自愈组中显著高于肝硬化组和肝癌组(P<0.01)。3个血清学指标的相关性分析显示,叶酸和MTHFR在各组均呈显著的正相关(P<0.01);在肝癌组中,HCY与叶酸和MTHFR也具有显著的正相关关系(P<0.01)。3个指标在终末期肝脏疾病患者(肝癌组和肝硬化组)不同临床特征的组别间分层分析显示,随着肝功能下降,血清HCY水平增高,且差异具有统计学意义(P<0.05);HBsAg(-)和HBV DNA(<500 copies/mL)的终末期肝病患者血清MTHFR和叶酸水平分别高于HBsAg(+)和HBV DNA(≥500 copies/mL)者(P﹤0.05)。结论男性、血清叶酸和MTHFR浓度降低是HBV感染后疾病恶性进展的风险因素。
Objective To analyze the levels of serum homocysteine (HCY), folic acid and methylenetetrahydrofolate reductase (MTHFR) and their relationship with the progression of liver diseases in patients with different stages of progression . Methods Hepatitis B self-healing group (15 males and 15 females; aged 37-66 years, mean age 52.90 years) were selected according to the principle of matching gender, age and genotype. The cirrhosis group (15 males and 15 females) (Age 36-73 years, average age 54.87 years) and liver cancer group (15 males and 15 females; aged 38-78 years, mean age 56.37 years), 30 subjects were enrolled in the study. ) Test kit for the detection of serum HCY, MTHFR and folic acid levels. Results Serum folic acid and MTHFR levels in the self-healing group were significantly higher than those in the cirrhosis and liver cancer groups (P <0.01). Correlation analysis of three serological markers showed that folic acid and MTHFR had significant positive correlation (P <0.01), and there was a significant positive correlation between HCY and folic acid and MTHFR in HCC (P <0.01) ). Hierarchical stratification analysis of the three indicators in different clinical characteristics of patients with end-stage liver disease (liver cancer group and cirrhosis group) showed that serum HCY level increased with the decline of liver function, and the difference was statistically significant (P <0.05 ). Serum MTHFR and folic acid levels were significantly higher in patients with end-stage liver disease with HBsAg (-) and HBV DNA (<500 copies / mL) than those with HBsAg (+) and HBV DNA (≥500 copies / mL) (P <0.05). Conclusions Male, serum folate and MTHFR concentrations are risk factors for the malignant progression of the disease after HBV infection.