血清肝纤维化指标与肝脏病理学对照观察

The control study of serum liver fibrosis indexes and liver pathology

目的评价血清肝纤维化指标诊断对于肝脏纤维化的临床价值。方法84例肝穿刺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)的水平。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[1]。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 senun samples 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 = 0.672, P 〈 0.01 ; r = 0.316, P 〈 0.01 ; r = 0.374 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 specificity HA〉 Ⅳ-C〉 PⅢP〉 LN. Conclusions Serum fibrosis index can predict the tendency of hepatic fibrosis.