CAJ | 학술논문

目的：探讨肝硬化合并肝癌患者血氨水平、层黏连蛋白和血小板参数变化与肝功能Child-Pugh分级间的关系。方法选取108例肝硬化合并肝癌患者（肝癌组），其中男71例，女37例，年龄37～71岁，平均55．6岁。按照Child-Pugh分级标准， A级28例，B级32例，C级48例。正常对照组67例，男41例，女26例，年龄37～62岁，平均46．8岁。采用化学发光法检测层黏连蛋白（LN），血氨（NH3）采用连续监测法，血小板参数用贝克曼库尔特五分类血常规分析仪检测。比较肝癌组与对照组、肝癌组Child-Pugh分级间的NH3水平、黏连蛋白（ LN）、血小板参数的变化。结果肝癌患者NH3、LN、MPV、PDW升高， PLT和PCT明显降低，与对照组相比，差异有统计学意义（P＜0．01）。随着Child-Pugh等级上升，NH3、LN、MPV、PDW逐渐升高，PLT和PCT下降，分级间比较差异有统计学意义（P＜0．01）。肝癌患者随着肝功能的下降，NH3与LN、PCT呈直线相关，与PLT、MPV、PDW无明确相关。结论联合观察血氨、层黏连蛋白与血小板指标变化对肝硬化合并肝癌无创伤诊断有一定的临床意义。
목적：탐토간경화합병간암환자혈안수평、층점련단백화혈소판삼수변화여간공능Child-Pugh분급간적관계。방법선취108례간경화합병간암환자（간암조），기중남71례，녀37례，년령37～71세，평균55．6세。안조Child-Pugh분급표준， A급28례，B급32례，C급48례。정상대조조67례，남41례，녀26례，년령37～62세，평균46．8세。채용화학발광법검측층점련단백（LN），혈안（NH3）채용련속감측법，혈소판삼수용패극만고이특오분류혈상규분석의검측。비교간암조여대조조、간암조Child-Pugh분급간적NH3수평、점련단백（ LN）、혈소판삼수적변화。결과간암환자NH3、LN、MPV、PDW승고， PLT화PCT명현강저，여대조조상비，차이유통계학의의（P＜0．01）。수착Child-Pugh등급상승，NH3、LN、MPV、PDW축점승고，PLT화PCT하강，분급간비교차이유통계학의의（P＜0．01）。간암환자수착간공능적하강，NH3여LN、PCT정직선상관，여PLT、MPV、PDW무명학상관。결론연합관찰혈안、층점련단백여혈소판지표변화대간경화합병간암무창상진단유일정적림상의의。
Objective To explore the relationship between the level of plasma ammonia and the change of serum laminin and platelet parameters in patients with liver cirrhosis and hepatocellular carcinoma with different degrees of their liver lesions .Methods A total of 108 patients with hepatic cirrhosis and liver cancer were enrolled , male 71, female 37, age 37~71 years old,mean age 55.6 years old.They were divided into three subgroups ( A,B,and C) on the basis of Child-Pugh classfication .Among the patients ,28 were classi-fied as Child-Pugh class A,32 class B,48 class C.67 healthy individuals served as controls ,male 41, female 26 ,age 37~62 years old,mean age 46.8 years old.Serum laminin(LN)was determined by chemiluminescence, platelet,s parameters were determined by Beckman coutter five categones of blood analyzer and plasma ammonia ( NH3 ) was determined by continuous monitoring method in 175 patients.The levels of NH3, LN,platelet,s parameters in patients were compared between liver cancer group and control group and beween child-pugh classificationsin liver cancer group lesions .Results Compared with the control group ,NH3,LN,MPV、PDW were increased in patients with cancer of the liver ,and PLT and PCT were decreased .There were singnificant differences between the two groups (P<0.01).with the increased degree of NH3,LN,MPV and PDW increased,PLT and PCT decreased.There were significant differences between the three classifications (P<0.01).NH3 and LN,NH3 and PCT were correlated with the decline in liver function , while NH3 was not significantlu correlated with PLT ,MPV,and PDW.Conclusions There is clinical significance of non-invasive diag-nosis based on the level changes of NH 3, LN and platelet parameter in patients with liver cirrhosis and hepatocellular carcinoma .