肝纤维化指标与HBV-DNA联合检测在肝纤维化诊断中的价值

Clinical application of serum markers of liver fibrosis and copy of HBV-DNA in the diagnosis of hepatic fibrosis

目的探讨血清肝纤维化指标在肝纤维化非创伤性检查中的临床意义,慢性乙型肝炎患者血清HBV-DNA病毒载量与血清肝纤维化指标变化的关系。方法 143例慢性乙型肝炎患者血清中透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原(PCⅢ)检测采用放免法;对乙型肝炎患者血清HBV-DNA含量及乙型肝炎病毒标志物(HBV-M)分别采用荧光定量聚合酶链反应及酶联免疫吸附试验检测,并进行比较分析。结果肝纤维化4项指标中HA和PCⅢ在慢性肝炎轻、中、重度和肝硬化患者中有依次升高趋势,差异有统计学意义(P<0.05)。同时在乙型肝炎病毒e抗原(HBeAg)阳性、HBV-DNA阳性组中血清肝纤4项指标最低,在HBeAg阴性、HBV-DNA阴性组呈中等偏高,而在HBeAg阴性、HBV-DNA阳性组中最高。结论 HBeAg阴性慢性乙型肝炎患者随HBV-DNA阳性和年龄增长,肝病持续发展,炎性和纤维化程度加重,肝纤维化4项指标与HBV-DNA联合检测对临床判断肝纤维化程度、肝硬化早期诊断和指导抗纤维化及抗病毒治疗有重要的价值。

Objective To study the clinical significance of the serum of liver fibrosis in the liver fibrosis nontraumatic check, and the relationship between changer of blood HBV DNA viral load and serum liver fibrosis markers levels in patients with chronic hepatitis B. Methods Serum levels of HA,LN,CⅣ ,PCⅢ in 143cases of chronic hepatitis B were detected by radioimmunoassay（RIA）, HBV-DNA were measured by the way of nucleic acid amplification fluorescent quantitation（FQ-PCR）, and hepatitis b virus markers（HBVM） were tested by using ELISA. Results There was significant difference in quantity of serum HA and PCⅡ of liver fibrosis four index of liver fibrosis in mild or moderate or severe chronic hepatitis and cirrhosis in turn increase trend（P〈0.05）. In the hepatitis b virus markers,serum markers of liver fibrosis of HBeAg positive and HBV-DNA positive group was minimum, serum markers of liver fibrosis of HBeAg negative and HBV-DNA negative group was medium on the high side,and serum markers of liver fibrosis of HBeAg negative and HBV-DNA positive group was the highest. Conclusion HBeAg negative chronic hepatitis b patients with HBV-DNA positive and age,liver disease continued to develop, and fibrosis was increasing. The liver fibrosis four index and HBV-DNA united detection have an important value on clinical judgment of liver fibrosis degree and guiding anti fibrosis and antiviral treatment.