Thornton J R, Losowsky M S
Department of Medicine, St James's University Hospital, Leeds.
Gut. 1989 Oct;30(10):1392-5. doi: 10.1136/gut.30.10.1392.
Plasma methionine enkephalin is increased in liver disease and may contribute to some of the clinical manifestations of hepatic failure. To determine if another 'small' opioid peptide is increased in the plasma of patients with liver disease, leucine enkephalin was measured by radioimmunoassay. Its plasma concentration was raised approximately five-fold in patients with acute liver disease (median 1490 pmol/l, range 830-2420) and three-fold in patients with cirrhosis with ascites (960 pmol/l, 470-2900), compared with disease controls (325 pmol/l, 180-740) and healthy controls (305 pmol/l, 180-560). The increase in plasma leucine enkephalin was proportional to the degree of liver damage, as judged in the patients with acute liver disease by its correlation with the prothrombin time (r = 0.691, p less than 0.01) and alanine aminotransferase (r = 0.502, p less than 0.05), and in the patients with cirrhosis by its negative correlation with the plasma albumin (r = -0.743, p less than 0.001). It is unclear whether the raised plasma leucine enkephalin in liver disease is a consequence of diminished hepatic inactivation, increased secretion from sympathetic nerves and adrenal glands, or both.
血浆中甲硫氨酸脑啡肽在肝脏疾病中升高，可能导致肝衰竭的一些临床表现。为了确定另一种“小”阿片肽在肝病患者血浆中是否升高，采用放射免疫分析法测定了亮氨酸脑啡肽。与疾病对照组（中位数325 pmol/l，范围180 - 740）和健康对照组（305 pmol/l，180 - 560）相比，急性肝病患者血浆亮氨酸脑啡肽浓度升高约5倍（中位数1490 pmol/l，范围830 - 2420），肝硬化腹水患者升高3倍（960 pmol/l，470 - 2900）。急性肝病患者中，血浆亮氨酸脑啡肽的升高与肝损伤程度成正比，这可通过其与凝血酶原时间（r = 0.691，p < 0.01）和丙氨酸转氨酶（r = 0.502，p < 0.05）的相关性判断；在肝硬化患者中，通过其与血浆白蛋白的负相关性（r = -0.743，p < 0.001）判断。目前尚不清楚肝病患者血浆亮氨酸脑啡肽升高是肝脏灭活减少、交感神经和肾上腺分泌增加的结果，还是两者共同作用的结果。
