肝纤维化血清学标志对慢性肝病的诊断价值

Diagnostic values of serum marke for liver flbrosis in patients with chronic liver diseases

目的:通过对肝硬化等慢性肝病者血清中透明质酸(hyaluronic acid,HA)、Ⅲ型前胶原(p(?)gen tyeⅢ,pcⅢ)含量的检测,探讨肝纤维化血清学标志对慢性肝病的诊断价值.方法:以健康对照组和其他胃肠疾病组为对照,放射免疫分析法测定血清中HA、pcⅢ含量,并将各组结果进行统计学分析,比较(方差分析,线性回归分析).结果:肝硬化代偿、失代偿期两组血清HA、poⅢ含量均显著高于健康对照组与胃肠疾病组(p<0.001).肝硬化组中,Child-Pugh’s A.B.C三组及其积分与血清HA.peⅢ含量之间均有非常显著的正相关关系(p<0.001,p<0.01).以血清HA≥165ug/L或pcⅢ≥148.2ug/L为临界值(cut-off value)的联合诊断指标比单项指标好,其灵敏度、特异性、阳性预示值分别是0.77,0.94和0.97.结论:作者认为,血清HA.pcⅢ可作为肝硬化诊断,病情程度判断及疗效观察的无创伤性、可动态监测的指标.

Aims:In order to demonstrate the diagnostic values of hyaluronic acid (HA) and procolla-gen type III (pc III) in liver fibrosis,the serum levels of HA and pc III in patients with liver cirrhosis, gastrointestinal diseases and healthy controls were measured. Methods: Radioimmunoassay (RIA) was used for the measurement of HA and PC III in serum of healthy controls, gastrointestinal diseases and liver cirrhosis. Results: The data showed that,both serum HA and pc III elevated significandy in patients with liver cirrhosis compared to controls and gastrointestinal diseases (p<0.001).In the group of pafienfs with liver cirrhosis, a positive correlation was found between serum HA, pc III levels and the Child-Pugh' s grades and scores (p<0.001 and p<0.01). The cut-off diagnostic values of cirrhosis were 165() g/L for HA or 148.2()g/L for PC III.combined HA and PCIII assay for the diagnosis was betterthan single. The sensitivity,specificity and positive predictive value were 0.77,0.94and 0.97 respectively. Conclusions; The authers considered that the serum HA and PC III levels might be an indicator of fi-brosis in liver cirrhosis and could be an useful and dynamic clinical tool for following fibrotic processes in liver cirrhosis, particularly in monitoring the response to treatment in controlled therapuntic trials.