肝活检病人血清纤维化指标的检测

DETECTION OF SERUM FIBROSIS INDEXES IN PATIENTS UNDERGOING LIVER BIOPSIES

①目的 探讨血清肝纤维化指标与慢性病毒性肝炎纤维化程度的关系及其临床应用价值。②方法对 36 6例慢性乙型病毒性肝炎病人进行了肝组织活检 ,同时检测其血清脯氨酸肽酶 (PLD)、Ⅳ型胶原 (CⅣ )、Ⅲ型前胶原氨基端肽 (PⅢNP)、层粘连蛋白 (LN)、透明质酸 (HA)含量 ,比较肝组织炎症和纤维化程度与血清肝纤维化指标的关系 ,并分析了肝纤维化指标与肝功、血常规之间的相关性。③结果 按肝脏的炎症程度分组 ,各组间PLD、CⅣ差异无显著性 (F =1 .79、1 .91 ,P >0 .0 5 ) ;PⅢNPG4组较G1、G2升高 ,差异有显著意义 (F =4 2 .33,q =3.2 0、4 .1 2 ,P <0 .0 5、0 .0 1 ,) ;LN水平随着炎症程度加重而增高 ,G1组与G2、G3、G4组比较差异均有显著性 (F =2 3.4 8,q =3.1 7～ 3.89,P <0 .0 5 ) ;G2、G3、G4组的HA水平较G1组增加 ,差异有显著意义 (F =2 3.0 3,q =3.2 2～3.97,P <0 .0 5 )。按肝脏纤维化程度分组 ,各组间比较 ,PLD差异无显著性 (F =1 .82 ,P >0 .0 5 ) ;CⅣ、LN、HA水平随着纤维化程度的加重而增高 ,S4组显著高于其他各组 (F =3.1 8～ 2 0 .34,q =4 .1 2～ 6 .0 4 ,P <0 .0 1 ) ;PⅢNP水平随着纤维化程度的加重而增高 ,S0组与S1、S2、S3、S4各组比较差异有显著性 (F =37.84 ,q =4 .75～ 7.31 ,P<0 .

Objective To explore the relationship between serum fibrosis indexes(SFI) and the fibrosis grades in patients with chronic viral hepatitis B(CHB) and their clinical significance. Methods Five serum fibrosis indexes (PLD, CⅣ, LN, PⅢNP , and HA) were detected. The relationship between hepatic inflammation, fibrosis degree, and SFI was analyzed. The correlation of SFI with the liver function and blood routine was also analyzed. Results By degree of inflammation, no remarkable differences of the PLD and CⅣ existed among the four groups ( F=1.79, 1.91; P >0.05). PⅢNP was significantly different ( F= 42.33;q=3.20,4.12;P <0.05,0.01). LN and levels increased with the severity of inflammation and was different between groups ( F=23.48;q =3.17-3.89;P <0.05). HA had similar results with LN ( F=23.03,q=3.22-3.97,P <0.05). They were classified into 5 stages on the basis of liver fibrosis, and found that there were no remarkable differences of PLD among different stages ( F=1.82,P >0.05). CⅣ, LN and HA levels increased with the fibrosis grades, and were much higher in Stage 4(S4) than in other stages ( F=3.18-20.34,q=4.12-6.04,P <0.01). The PⅢNP level also increased with fibrosis grades, and that of S0 was remarkably different from those of S1, S2, S3 and S4 ( F=37.84,q=4.75-7.31,P <0.05,0.01). The fibrosis indexes had negative correlation with A, PA, WBC, RBC, and PLT ( r=-0.51--0.79,P <0. 05), and positive correlation with TB, DB, G and ALT( r=0.42-0.63,P <0.05), but had no correlation with AKP and γ-GT ( r=0.03-0.09 ,P >0.05). Conclusion CⅣ, LN, and HA levels can be reliable indexes for determining the liver inflammation and fibrosis degree in CHB, and are of more value if they are tested with liver function and routine blood tests.