血清肝纤维化指标与肝脏病理学对照观察

The Contrast Study of Serum Liver Fibrosis Indexes and Liver Pathology

目的评价血清肝纤维化指标对于诊断肝脏纤维化的临床价值。方法84例肝穿确诊的慢性乙型肝炎患者,检测透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原肽(PⅢP)、层黏连蛋白(LN)水平。对肝组织纤维化病理分期与血清纤维化指标进行对比分析。结果Ⅳ-C、HA、PⅢP、LN与肝组织纤维化病理分期的相关系数分别为0.672(P<0.01)、0.316(P<0.01)、0.374(P<0.05)、0.066(P>0.05)。除LN外,其余指标水平均随着肝组织纤维化程度的加重而逐渐上升,且Ⅳ-C、HA、PⅢP的S3、S4期水平与S1、S2期比较有统计学差异(P<0.01)。S4期作为早期肝硬化诊断标准,通过ROC曲线分析Ⅳ-C、HA、PⅢP、LN的曲线下面积分别为0.901、0.764、0.756、0.434。敏感度:Ⅳ-C>PⅢP>HA>LN;特异度:HA>Ⅳ-C>PⅢP>LN。结论血清肝纤维化指标对肝组织病理纤维化程度的判断有指导意义。

Objective To evaluate the clinical value of serum fibrosis index in the diagnosis of hepatic fibrosis. Methods 84 serum sampies from patients with chronic hepatitis B were detected by RIA and EIA for fibrosis indexes including HA ,PⅢP,LN and Ⅳ-C. liver biopsy were performed in all patients. Results Ⅳ-C, HA, PⅢP correlate positively with stage of fibrosis （ r=0. 627, P 〈 0. 01 ;r = 0.316, P 〈 0. 01 ; r = 0.347, P 〈 0. 05 ）. ROC analysis showed that the AUCs of Ⅳ-C, HA, PⅢP and LN were 0. 901,0. 764,0. 756,0. 434, respectively, when S = 4 as positive criteria for diagnosing early liver cirrhosis. The sensitivity Ⅳ-C 〉 PⅢP 〉 HA 〉 LN, the specificlty HA 〉 Ⅳ-C 〉PⅢP 〉 LN. Conclusion Serum fibrosis index can orodiet the tendency of hepatic fibrosis.