联合检测血清HA、CⅣ、LN及ALPⅤ对肝纤维化的诊断价值

THE VALUE OF SIMULTANEOUS DETERMINATION OF SERUM HYALURONIC ACID, COLLAGEN TYPE Ⅳ ,LAMININ LEVEL AND ALPⅤ TO THE DIAGNOSIS OF LIVER FIBROSIS

目的 :探讨血清透明质酸 (HA)、 型胶原 (C )、层粘蛋白 (LN)及碱性磷酸酶同工酶 (AL P )对肝纤维化的诊断价值。方法 :对 12 7例正常人、急慢性肝炎及肝纤维化病人 ,采用放免法测定其血清 HA、C 、L N,采用聚丙烯酰胺凝胶电泳分离法测定血清 AL P ,并对 HA、C 、L N结果及 AL P 阳性率与 γ球蛋白、A/G间分别作直线相关分析及等级相关分析。结果 :肝纤维化组血清 HA、C 、L N法结果分别为 5 5 4.0± 2 2 1.7μg/L、2 49.2± 92 .7μg/L、32 5 .4± 10 6 .0 μg/L,均较其它组明显升高 (P<0 .0 1) ;AL P 在肝纤维化组阳性例数也明显高于其它组。HA、C 、L N三者分别以 2 5 8.1μg/L、12 9.0 μg/L 及 12 2 .0 μg/L为阳性界值 ,与 ALP 间分别作二、三、四项联合检测 ,其敏感性、特异性、准确性以 HA+C 、HA+ALP 作二项联检最优 ,两组分别达 97.8%、89.3%、91.0 %及 98.5 %、85 .8%、91.0 %。相关分析结果显示 ,血清四项指标与 γ球蛋白及 A/G比例分别呈正、负相关趋势。结论 :HA、C 、LN及 ALP 对肝纤维化均具有较好的诊断价值 ,联合检测 ,可显著提高诊断敏感性 ,尤以 HA+C 及 HA+AL P

Objective:To study the value of simultaneous determination of serum hyaluronic acid(HA), collagen type Ⅳ(CⅣ) ,laminin(LN) level and Alkaline phosphatase isoenzyme-V(ALPⅤ) to the diagnosis of liver fibrosis. Methods: Serum HA,CⅣ,LN were mearsured with radioimmunoassay. ALPⅤ were separated with a vertical slab stage gradient polycrylamide gel electrophoresis. Serum HA, CⅣ,LN and ALPⅤ were analyzed in 23 cases with acute hepatits, 15 cases with mild chronic hepatitis,19 cases with moderate chronic hepatitis,45 cases with posthepatitic cirrhosis ,25 healthy persons. Results: The levels of serum HA,CⅣ and LN in posthepatitic cirrhosis are 554.0±221.7μg/L,249.2±92.7μg/L,325.4±106.0μg/L, respectively.All of them were significantly higher than those in other groups.(P<0.01). The positive rate of ALPⅤ in level fibrosis was also significantly higher than in other diseases. HA>258.1μg/L ,CⅣ>129.0μg/L ,LN>122.0μg/L and positive ALPⅤ were chosen as the diagnostic standard. Simultaneous determination of these indices may raise the diagnostic efficiency. The diagnostic sensitivity, specificity and accuracy were 97.8%,89.3%,91.0% for HA and ALP, and 98.5%,85.8%,91.0% for HA and CⅣ. The four indices positively correlated with gamma globulin and negatively correlated with albumin-globulin ratio(A-G ratio) . Conclusion: Serum HA,CⅣ and LN are all valuable in the diagnosis of liver fibrosis. Simultaneous determination of them will enhance sensitivity highly. Simultaneous determination of HA and CⅣ or HA and LN are more efficient. [