血清肝纤维化指标与B超部分肝实质图象的比较

Comparison Study of Serum Liver Fibrosis Indexes and B Untrasonography Images

目的 :为了解早期肝纤维化的B型超声波检查 (B超 )结果与血清肝纤维化指标之间的相关性。方法 :除去B超示占位性病变和 (或 )腹腔积液者 ,对B超肝实质回声显示“光点较粗较密 ,分布尚均”的 136例 (第一组 )和肝实质回声示“光点粗 ,分布不均匀 ,呈条索状或蜂窝状或斑片状改变”90例 (第二组 ) ,进行了血清透明质酸 (HA)、Ⅲ型前胶原 (PCⅢ )、Ⅳ型胶原(ⅣC)和层粘连蛋白 (LN)测定。结果 :两组患者的血清肝纤维化指标检测阳性率以HA最高 ,ⅣC次之 ,PCⅢ和LN较低。第一组HA和 -ⅣC阳性率低于第二组 ;其中HA阳性率在两组间有显著差异 (P <0 .0 1)。另外二项检测指标在两组间无可比性。第一组中 10 8例无脾肿大者可以视作基本正常图象 ,但HA、PCⅢ、Ⅳ -C和LN的阳性率分别为 6 8.5 %、4 2 .6 %、6 4 .8%和 4 4 .4 %。第二组B超图象呈明显病变 ,但有 8.9%患者肝纤维化指标阴性 ,与B超图象未达一致性。结论 :四项血清纤维化指标与B超的相关性HA >Ⅳ -C >PCⅢ和LN ,HA是比较理想的早期诊断指标。血清纤维化指标与B超的不一致性可能为患者肝脏处于炎症和纤维化静止期。

Objective: To investigate the correlation between B untrasonography and serum liver fibrosis indexes in early liver fibrosis. Methods: The patients with liver tumor and/or ascites diagnosed by B untrasonography were exculded. 136 cases whose echoes signal were relatively thick, close and equally distributive were selected as group l, Other 90 cases whose echoes signal were thick, unequally distributive and showed corded or areloated or aptchy change were selected as group 2. The serumhyaluronic acid (HA), procollagen Ⅲ(PCⅢ), collagen Ⅳ(ⅣC) and lamnin (LN) were detected. Results: The positive rate of the serum index from high to low were HA, ⅣC, PCⅢ and LN in both groups. The positive rate of HA and ⅣC in group 1 were lower than that of group 2, and the difference of HA was significant (P<0.01). No obvious difference was found in the other two indexes. In group 1, images of 108 cases with no splenomegaly were considered as normal, while the positive of HA, PCⅢ, ⅣC and LN were 68.5%, 42.6%, 64.8% and 44.4%, respectively. In group 2, B untrasonography images showed obviously pathological changes, inconsistently, the liver fibrosis indexes of 8.9% patients were negative. Conclusion: Correlations between the four serum liver fibrosis indexes and the images of B untrasonography from high to low were HA, ⅣC, PCⅢ and LN. HA is a good marker of early diagnosis. The inconsistence between the serum fibrosis index and the images of B ultrasonography might because of liver inflammation of silence period of fibrosis.