The Clinical Significance Of Patients With Liver Disease Unconjugated Bilirubin Increased

Objective：The most common clinical liver diseases include viral hepatitis, fatty liverdisease, and cirrhosis caused by various factors. The cirrhosis is the advanced stage ofvarious liver diseases. The irreversibility of its histopathology and the complicatedcomplications caused by it have burdened much on patients’ body and spirit. At thesame time, it has caused a great confusion for doctor’s therapeutic schedule.According to the existing literature shows that, the level of conjugated bilirubin (CB)and that of the unconjugated bilirubin (UCB) increases in hepatocellular jaundicepatients. And generally, the level of CB is higher than the level of UCB. However, weclinically find in the liver disease patients that purely elevated UCB in the liverfunction test is always seen. In this way, is the elevated unconjugated bilirubin anindication of the deterioration of liver function or a sort of self-protection of body? Isthere any clinically predicting role on the severity of liver damage and the forepartcirrhosis? This is still uncertain. Thus, this paper is at the aim of revealing therelevance between the elevated unconjugated bilirubin and the hepatic fibrosis degreein the patients with the common liver diseases, giving a reference for the judging ofliver damage degree, and for the early diagnosis and clinic therapies to the cirrhosis.Methods：The study subjects were adult patients among the outpatients and hospitalizedpatients from Medical Department and Surgery Department of Hepatopancreatobiliaryin the Department of Jilin University, First Clinical Hospital during November1st,2013to November30th,2014. They were all diagnosed as liver diseases, includingchronic hepatitis B, chronic hepatitis C, non-alcoholic fatty liver disease(NAFLD) andcirrhosis caused by above factors with elevated UCB(the CB level is normal) andelevated or normal total bilirubin(TBIL) but excluding of hemolysis and cancer. Inturn different types of liver disease were selected to match the specific matchinggrouped as follows:(1)82cases with chronic viral hepatitis, including63cases ofchronic viral hepatitis B and19cases of chronic viral hepatitis C; they were1:3 matched, according to the age and gender:1) there were189cases of chronic viralhepatitis B(serum TBIL, CB and UCB were all in the normal level), and57cases ofchronic viral hepatitis C(serum TBIL, CB and UCB were all in the normal level).Then matched another246cases (serum TBIL, CB and UCB were all in the normallevel) from the Center of Health Examination.(2)94cases with NAFLD, which were1:3matched, according to the age and gender:1) there were282cases ofNAFLD(serum TBIL, CB and UCB were all in the normal level), then matchedanother282cases(serum TBIL, CB and UCB were all in the normal level) from theCenter of Health Examination. The author calculated retrospectively the patients’materials by the medical record query system and the outpatient system in theDepartment of Jilin University, First Clinical Hospital. After the careful collection ofthe patients’ case information, then the author calculated the data in statistical ways,using the retrospectively analysis method, exploring the clinical significance of pureunconjugated bilirubin rising in non-alcoholic fatty liver disease and chronic viralhepatitis. And analyzed the correlation between unconjugated bilirubin and liverhardness, thickness of spleen, platelet levels, and hepatitis B virus copy.Results：1. Comparison between chronic viral hepatitis patients with elevated UCB and healthexamination people with normal UCB:(1) The level of AST, ALT, GGT, TBIL, CB and Hb are all higher in chronic viralhepatitis patients with elevated UCB than that of in health examination people,p<0.05.(2) The level of ALB, WBC, PLT in chronic viral hepatitis patients with elevatedUCB are all lower than that of in health examination people, p<0.05.(3) The level of ALP has no difference between the chronic viral hepatitis patients andhealth examination people, p>0.05.2. Comparison between the chronic viral hepatitis patients with elevated UCB and thechronic viral hepatitis patients with normal UCB:(1) The level of AST, ALT, GGT, ALP, liver stiffness, fat attenuation, WBC has nodifference between the chronic viral hepatitis patients with elevated UCB and the chronic viral hepatitis patients with normal UCB, p>0.05.(2) The level of ALB, TBIL, CB, Hb and PLT in chronic viral hepatitis patients withelevated UCB are all higher than that of in the chronic viral hepatitis patients withnormal UCB, p<0.05.3. The relevant comparison between UCB and other factors in the chronic viralhepatitis patients with elevated UCB:The UCB level is positively associated with the TBIL level, liver stiffness andspleen thickness while is negatively correlated with the PLT level.4. Comparison of HBV-DNA quantitative between the chronic viral hepatitis patientswith different levels of UCB:The UCB level in chronic viral hepatitis patients with normal UCB isapparently higher than that of in chronic viral hepatitis patients with elevated UCB,p<0.05.5. Comparison between NAFLD patients with elevated UCB and health examinationpeople with normal UCB:(1) The level of AST, ALT, GGT, TBIL,CB, WBC, Hb, TCHO, LDL-C and TG are allhigher in NAFLD patients with elevated UCB than that of in health examinationpeople, p<0.05.(2) The level of ALB, PLT, HDL-C in NAFLD patients with elevated UCB are alllower than that of in health examination people, p<0.05.(3) The level of ALP has no difference between the NAFLD patients with elevatedUCB and the health examination people, p>0.05.6. Comparison between the NAFLD patients with elevated UCB and the NAFLDpatients with normal UCB:(1) The level of AST, ALT, GGT, ALP, fat attenuation, PLT, TCHOand HDL-C has no difference between the NAFLD patients with elevated UCBand the NAFLD patients with normal UCB, p>0.05.(2) The level of ALB, TBIL,CB, WBC, Hb, LDL-C and TG inNAFLD patients with elevated UCB are all higher than that of in the NAFLDpatients with normal UCB, p<0.05. (3) The liver stiffness in NAFLD patients with elevated UCB is lesssevere than that in the NAFLD patients with normal UCB, p<0.05.7. The relevant comparison between UCB and other factors in the NAFLD patientswith elevated UCB:The UCB level is positively associated with the TBIL level and the CB levelwhile has little correlation with the liver stiffness.Conclusion：Comparing with the healthy people, the NAFLD, the chronic hepatitis B and thechronic hepatitis C patients are more prone to suffer from liver function damage, liversynthetic ability weakening and lipid metabolism disorders.The NAFLD patients with high triglyceride levels may inhibit the key enzyme ofunconjugated bilirubin transport--BGT, resulting in elevated UCB. At the same time,the elevated UCB in the NAFLD patients could form a protective mechanism whichhas the function of oxidative stress response, anti-inflammatory and anti-fibrotic forhepatic cells, preventing the further damage of them. In the chronic viral hepatitispatients with purely elevated UCB, the higher the UCB level is, the more severe theliver fibrosis degree is, the thicker the spleen is, and the more serious the PLT damagedegree is.For the chronic hepatitis B patients, the elevated UCB may enforce the activityof heme oxygenase-1within the body, inhibiting the replication of the HBV. And ifthe HBV-DNA quantitative is relatively low, the replication activity of the HBV willbe down, which means the live fibrosis degree in the chronic hepatitis B patients isrelatively serious.