소아의 B형 바이러스성 간염과 혈청 α-fetoprotein농도와의 연관관계

Abstract

[한글]

α -Fetoprotein은 albumin과 유사한 구조를 갖는 590개의 아미노산으로 구성된 혈청단백으로, 임신 4주경부터 난황막 및 정상 태아의 간, 위장관계에서 합성되어, 태생 13주경에 혈중농도는 최고치를 이룬 후에 감소하기 시작하며 출생후 8개월전에 성인 수준인 20ng/m1이하로 존재한다. 그러나 원발성간암,간아세포종(hepatoblastoma), 배세포 종양(germ cell tumor), 융모막 암종(chorcarcinoma) 환자에서 α-fetoprotein이 증가되어 있어 종양 표지인자(tumor marker)로서 임상적으로 이용되고 있다.

종양 이외에도 성인에서 급성 및 만성 B형 간염에서, 또한 간의 부분절제 후 간재생시, 실험적 사염화탄소 급성 중독시에 α-fetoprotein이 증가된다고 알려져 있다. 이러한 증가는 혈청 aspartate aminotransferase(AST) 및 alanine aminotransferase(ALT)의 상승정도와도 밀접한 연관 관계가 있다고 보고되고 있다.

그러나 소아의 B형 바이러스성 간염에서 혈청 α-fetoprotein농도의 증가여부는 아직 이론이 많은 실정이며, 우리나라에서는 이에 대한 보고가 미흡한 실정이다.

따라서 본 연구에서는 소아의 B형 바이러스성 간염과 혈청 α-fetoprotein농도와의 연관 관계를 알아 보고자 하였으며, 다음과 같은 결과를 얻었다.

1. 소아 B형 바이러스성 간염환아에서 혈청 α-fetoprotein 농도는 대조군 및 비 B형 간염군에 비해 의의있게 높았다.

2. 소아의 B형 바이러스성 간염에서 혈청 α-fetoprotein 농도는 HBe 항원 존재 유무와 차이가 없었다.

3. 소아의 B형 바이러스성 간염에서 혈청 α-fetoprotein 농도와 혈청AST 및 ALT 농도와는 각각의 자연대수값과 의의 있는 상관 관계를 나타내었다(p<0.05).

4. 소아의 B형 바이러스성 간염에서 HBs 항원이 양성에서 음성으로 전환될 때 혈청 α-fetoprotein농도가 급변하게 상승하였다.

이상의 곁과로 보아 소아의 간염에서 혈청 α-fetoprotein 농도는 HBb 항원양성인 B형 바이러스성 간염군에서 의의있게 상승되고, 간기능 악화와 HBe항원 소실이 혈청 α-fetoprotein농도 상승과 관계있는 것으로 생각된다.

The correlationship between serum α-fetoprote levels and hepatitis B in children

Kyu Hong Yon

Department of Medical Science, The graduate School, Yonsei University

(Directed by Professor Kyung Hwan Kim )

α -Fetoprotein consist 590 amino acid are similar to those of albumin, and is

synthesized mainly by the yolk sac, fetal liver and gastrointestinal tracts. Human

α-fetoprotein trace is detectable at 4 weeks of gestation and peak at 13 weaks of

gestation, then decrease to adult level within 8 months after delivery. Recurrence

of elevated α -fetoprotein levels frequently occures during adult life in patient

with hepatocellular carcinoma, thyroid tumor, germ col 1 tumor, chorionic

carcinoma. So that was used clinically as a tumor marker. More recently,

radioiimnlnoassay techniques have shawn that α -fetoprotein can be detected in

concentrations of less than 20 ng/ml. Using this highly sensitive method, it has

shown that senlm α -fetoprotein increased in patients with acute and chronic liver

disease, especially hepatitis S viral infection. However, serum α-fetoprotein

levels in children with hepatitis B are still controversial and have rarely been

subject of investigation. So this study was aimed to deterMine the relationship

between serum α-fetoprotein levels and hepatitis B in children. The results were

summarized as follows.

1. Serum α-fetoprotein levels in children with HBs-positive hepatitis were

elevated significantly compared to that of control and hepatitis were trout HBs

antigen.

2. There was no significant difference in serum α -fetoprotein level between

hepatitis B in children wi th and without HBe antigen.

3. Logarithms of serum α -fetoprotein levels correlated with logarithms of serum

aspartate aminotransferase( AST ) and alanine aminotransferase( ALT )level s.

4. Striking elevation of serum α -fetoprotein levels found in three children

with hepatitis B at HBe antigen clearance from positive to negative.

In conclusion, serum α -fetoprotein levels is significantly elevated in children

with HBs-positive hepatitis, that may correlate wi th aggrevation of liver function

and HBe antigen clearance.

[영문]

α -Fetoprotein consist 590 amino acid are similar to those of albumin, and is synthesized mainly by the yolk sac, fetal liver and gastrointestinal tracts. Human α-fetoprotein trace is detectable at 4 weeks of gestation and peak at 13 weaks of

gestation, then decrease to adult level within 8 months after delivery. Recurrence of elevated α -fetoprotein levels frequently occures during adult life in patient with hepatocellular carcinoma, thyroid tumor, germ col 1 tumor, chorionic carcinoma. So that was used clinically as a tumor marker. More recently, radioiimnlnoassay techniques have shawn that α -fetoprotein can be detected in concentrations of less than 20 ng/ml. Using this highly sensitive method, it has

shown that senlm α -fetoprotein increased in patients with acute and chronic liver disease, especially hepatitis S viral infection. However, serum α-fetoprotein levels in children with hepatitis B are still controversial and have rarely been subject of investigation. So this study was aimed to deterMine the relationship between serum α-fetoprotein levels and hepatitis B in children. The results were summarized as follows.

1. Serum α-fetoprotein levels in children with HBs-positive hepatitis were elevated significantly compared to that of control and hepatitis were trout HBs antigen.

2. There was no significant difference in serum α -fetoprotein level between hepatitis B in children wi th and without HBe antigen.

3. Logarithms of serum α -fetoprotein levels correlated with logarithms of serum aspartate aminotransferase( AST ) and alanine aminotransferase( ALT )level s.

4. Striking elevation of serum α -fetoprotein levels found in three children with hepatitis B at HBe antigen clearance from positive to negative.

In conclusion, serum α -fetoprotein levels is significantly elevated in children with HBs-positive hepatitis, that may correlate wi th aggrevation of liver function and HBe antigen clearance.