肝纤维化相关血清标志物的联合检测与临床应用研究

Liver fibrosis correlation blood serum designated object union examination and clinical practice research

目的对各型肝炎及活动期肝硬化肝纤维化相关血清标志物的检测与综合分析,以确定判断慢性肝病患者肝纤维化的常规指标。方法对190例各型肝炎患者行肝纤维化四项即血清透明质酸(hyaluronic acid HA),Ⅲ型前胶原肽(typeⅢprocollagen PCⅢ),层粘蛋白(laminin LN),及Ⅳ型胶原(typeⅣcollagenⅣC)及PGA指数即PT(凝血酶原时间),APOA1(载脂蛋白A1)、GGT(r-谷氨酰基转移酶)等肝纤维化相关血清指标的检测,同时进行B超检查。首先根据病史、肝功能、B超对患者进行分类,然后将所测定各项结果用流行病学方法,进行χ2检验确立统计学意义,分析各类型患者的肝纤维化相关血清指标。结果急性肝炎中,HA、LN、PCⅢ、ⅣC均有轻度升高,与对照组有明显差异(P<0.05),提示此四项指标与肝脏炎症活动有一定相关性。PGA指数无明显改变;慢性轻度肝炎时,HA、LN、PCⅢ、ⅣC仅轻度增高,PGA指数也轻度升高,与对照组无明显差异(P>0.05);在慢性肝炎中、重度及活动性肝硬化时PGA指数和HA、LN、PCⅢ、ⅣC均明显升高,均存在显著性差异(P<0.01),并以HA为最高,提示HA为诊断纤维化最敏感指标;同时中重度慢性肝炎患者B超部分提示弥漫性肝损害,其中肝纤维四项明显升高,考虑有早期纤维化的存在。结论我们认为联合PGA指数与肝纤维化血清标志物的检测可作为判断慢性肝病患者肝纤维化的常规指标。

Objective To each hepatitis and active stage liver cirrhosis liver fibrosis correlation blood serum designated object examination and generalized analysis, by determines the judgment chronic disease of fire liver patient liver fibrosis the conventional target.Methods To 190 example each hepatitis patient good liver fibrosis four items is the blood serum hyaluric acid （hyaluronic acid HA）, Ⅲ precollagen peptide （type Ⅲ procollagen Pcm ）Level mucinum （laminin LN） ,and Ⅳ cocollagen （type Ⅳcollagen ⅣC） and the PGA index is PT （zymoplasm original time） ,APOA1 （carries lipoprotein A1） ,GGT （r-valley aminoacyl transferase） and so on the liver fibrosis correlation blood serum target examinations, simultaneously carries on the B ultra inspection. First according to the medical history, the liver function, B surpasses to the patient carries on the classification, then will determine each result to use the epidemiology mcthod, carries on the chi - square test establishment statistics significance, analyzes various types patient＇ s liver fibrosis related blood serum target. Results In acute hepatitis, HA, LN, PC Ⅲ, ⅣC has the mild ascension, has the obvious difference with the control group （P 〈 0.05） ,prompts this four targets and the liver inflammation activity has certain relevance,the indexchanges not obviously; When chronic mild hepatitis, HA, LN, PC Ⅲ, Ⅳc only mildly advances, the PGA index also mildly elevates, With control group not obvious difference（ P 〉 0.05） ;When chronic hcpatitis specific weight and activity liver cirrhosis PGA index and HA, LN, PCⅢ, ⅣC obviously elevates, has the significance difference （ P 〈 0. 01）, and take HA as highest, prompts HA diagnoses the fibrosis most sensitive target;simultaneously specific weight chronic hepatitis patient B ultra part prompt proliferating liver harm, liver textile fiber four obvious ascensions, considered has the early fibrosis existence. Conclusion We thought unites the PGA index and the liver fibrosis blood serum designated object examination may take the judgment chronic disease of the liver patient liver fibrosis conventional target.