肝病患者纤维化不同分期时肝左叶上下径和前后径的测定及意义

Measurement and significance of oblique occipital frontal diameter and superior inferior diameter of hepatic left lobulus in patients with hepatic fibrosis

目的研究慢性肝炎患者纤维化不同分期时肝左叶上下径、前后径的变化规律及其联合血清纤维化指标对无创诊断中晚期肝纤维化或早期肝硬化的价值。方法经肝活检确定７２例慢性肝炎患者肝纤维化分期。肝穿前一日， Ｂ超测定肝左叶上下径、前后径等及肝穿刺点定位。放射免疫法测定血清 ＨＡ、 ＬＮ、 Ｃ ＩＶ和 ＰＣⅢ含量。结果随纤维化程度增加，肝左叶上下径呈缩短趋势，其Ｓ_４期测值为（５．７±１．５） ｃｍ明显短于Ｓ_０期测值（７．７±１．４） ｃｍ；肝左叶前后径呈增长趋势，其Ｓ_４期测值长于Ｓ_０期分别为（６．５ ±１．１） ｃｍ和（５．３ ± ０．７） ｃｍ。血清ＨＡ、ＬＮ、 ＣⅣ和ＰＣⅢ含量亦随纤维化增加而升高， ＨＡ、 ＰＣⅢ在Ｓ_３期开始显著升高，均高于同组Ｓ０期［（２７３．４±１３１．３）μｇ／Ｌ对（６６．２ ±３５．０）μｇ／Ｌ、 （１６７．４±４８．１）μｇ／Ｌ对（１０３．４± ２３．８）μｇ／Ｌ］。结论肝左叶上下径、前后径及血清ＨＡ、 ＰＣ Ⅲ含量变化可能间接反映了活动性肝纤维化中晚期或早期肝硬化。

Objective To study the changes and significance of oblique occipital frontal diameter (OFD) and superior inferior diameter (SID) of the hepatic left lobulus in different stages of hepatic fibrosis, and to evaluate the value of corresponding serological examination in the non-invasive diagnosis to hepatic fibrosis and cirrhosis. Methods Sev- enty-two patients with chronic hepatitis were confirmed by biopsy. OFD and SID of the hepatic left lobulus were measured by type B ultrasonic flaw detector. Serum levels of hyaluronic acid (HA), laminin (LN), type Ⅳ collagen (CⅣ) and type Ⅲ procollagen (PCⅢ) were measured by radioimmunoassay. Results SID of the hepatic left lobulus in S4 stage was 5.7 cm ±1.5 cm, significantly shorter than the values of 7.7cm ±1.4 cm in So stage. OFD of the hepatic left lobulus was longer in S4 stage than So stage, but the difference didn't reach statistical significance. Serum levels of HA, LN,CⅣ， and PCⅢ elevated as the increase of fibrosis. HA and PC Ⅲ increased to 273.4 μｇ/L ±131 .3 μg/L and 167.4μ'g/L ±48.1μg/L in S_3 stage from 66.2 μg/L ± 35.0 μg/L and 103.4 μg/L ±23.8 μg/L in So stage. Conclusion Changes in of SID and OFD of the hepatic left lobulus and serum levels of HA and PC Ⅲ may indicate indirecdy mid-late hepatic fibrosis or early cirrhosis.