慢性肝病患者血清PCⅢ水平与肝纤维化程度的关系

Correlation Between Serum Level of PCⅢ and the Degree of Hepatic Fibrosis in Patients with Chronic Liver Diseases

目的:探讨慢性肝病患者血清Ⅲ型前胶原(PCⅢ)水平与肝纤维化病变程度的相关性及进程的分级判定作用。方法:采用放射免疫分析(RIA)与自动生化仪化学法测定70例正常对照(仅测定PCⅢ水平)、32例慢性中度乙肝、27例慢性重度乙肝、27例肝炎肝硬化、39例原发性肝癌血清中PCⅢ的含量和肝功能相关酶,如丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)活性以及其他常规肝功能项目,如总胆红素(STB)、直接胆红素(SDB)、总蛋白(TP)、白蛋白(ALB)、总胆汁酸(TBA),分析不同组别的血清PCⅢ水平与肝纤维化程度的相关性及与其他检测项目的关系。结果:①血清PCⅢ水平依次为:慢性重度乙肝组(n=27,501.17±191.09)>肝炎肝硬化组(n=27,334.52±139.14)>正常对照组(n=32,298.02±151.02)>原发性肝癌组(n=39,281.42±143.48)>正常对照组(n=70,122.56±92.94);②慢性重度乙肝组血清PCⅢ水平与STB和SDB正相关(均P<0.05),与ALP显著正相关(P<0.01);③肝炎肝硬化组PCⅢ与STB、SDB、TBA及ALP显著正相关(均P<0.01);④慢性中度乙肝组血清PCⅢ水平与AST及ALP显著正相关(均P<0.01);⑤原发性肝癌组的血清PCⅢ与STB、SDB、TBA、AST及ALP显著正相关(均P<0.01)。结论:血清PCⅢ水平可反映肝纤维化的活跃状态,而非肝纤维化的最终病变程度。

Objective To study the correlation between serum level of PC Ⅲ and the degree of liver fibrosis in patients with chronic liver diseases. Methods Serum level of PC Ⅲ was assayed with RIA and other markers of liver function （ including ALT, AST, STB, SDB, TP, ALB, TBA） were assayed with automatic biochemical analyzer in 188 patients with various chronic liver drseases. PC Ⅲ only were examined in 70 controls. Results ① The serum levels of PC Ⅲ were in this order： chronic severe hepatitis （ n = 27, 501.17 ＋ 191.09） 〉 liver cirrhosis from chronic hepatitis（ n = 27,334.52 ＋ 139.14） 〉 chronic moderate hepatitis （n = 32,298.02 ＋ 151.02） 〉primary liver cancer （n =39,281.42 ＋143.48） 〉normal controls （n =70,122.56 ＋92.94）. ②The serum levels of PC Ⅲ were positively correlated with STB and SDB levels （P 〈0.05 ） in patients with chronic severe hepatitis and was significantly positively correlated with ALP levels （P 〈 0.01 ）.③ The serum level of PC Ⅲ were significantly positively correlated with STB, SDB, TBA and ALP in patients with cirrhosis from chronic hepatitis （P 〈0.01 ）. ④The serum levels of PCⅢ were significantly positively correlated with AST and ALP levels in patients with chronic moderate hepatitis （P 〈 0.01 ）. ⑤ The serum levels of PC Ⅲ were significantly positively correlated with STB, SDB, TBA, AST and ALP in patients with primary liver cancer （P 〈 0.01 ）. Conclusion Serum level of PC Ⅲ might adequately reflect the activity of the process of hepatic fibrosis, but did not necessarily reflect the degree of fibrosis already attained.