肝硬化患者Child-Turcotte分级与病理诊断预后及纤维化指标关系的研究

The relation between Child-Turcotte classification and pathology, diagnosis, prognosis and fibrosis index

目的 探讨肝硬化患者Child Turcotte(CTC)分级与病理及肝纤维化指标关系及其意义。方法 采用酶联免疫吸附方法 (ELISA)和放射免疫分析方法 (RIA)测定患者血清透明质酸 (HA)、Ⅲ型前胶原 (PCⅢ )、层粘蛋白 (LN)和Ⅳ型胶原 (Ⅳ C)水平 ,并观察病理改变。结果 HA可反映肝硬化严重程度 ,PCⅢ、LN、和Ⅳ C不反映肝硬化的严重性 ,CTC与病理改变有一致性 ,在B级及C级患者与病理诊断符合率达 97.8/%;A级患者 95 .5 /%好转 ,C级 96.9/%的病死率。结论 CTC与肝纤维化程度、肝脏病理改变的严重程度以及患者的预后有密切关系 ,在临床上对反映肝硬化的程度有实用价值。

Objective To study the relation between Child Turcotte classification and pathology, diagonsis, prognosis and fibrosis index as well as its significance. Methods The levels of hyaluronic acid(HA), type Ⅲ procollagen(PCⅢ), Laminin(LN) and type Ⅳ collagen(Ⅳ C) were detected by enzyme linked immunoadsordent assay(ELISA) or radioimmunoassay(RIA). Pathomorphology was observed in 68 patients with cirrhosis. Results Level of HA in serum was positively correlated with cirrhotic severity, but other fibrosis indexes could not reflect cirrhotic severity. Child Turcotte classification was concordant with the pathological changes. The concordance rate of Child Turcotte classification B or C patients with pathologic diagnosis was up to 97.8%. The recovery rate of Child Turcotte classification A patients was up to 95.5%. Fatality rate of Child Turcotte classification C patients was up to 96.9%. Conclusion Child Turcotte classification is closely correlated with the severity of hepatic fibrosis, severity of pathological changes in liver and prognosis of patients. It is of clinical value in the reflection of severity of hepatic cirrhosis.