慢性肝炎肝纤维化血清学指标与肝组织病理的相关性分析

The Relationship between Serum Markers of Liver Fibrosis and Liver Histopathologic Changes in Patients with Chronic Hepatitis

【目的】探讨肝纤维化血清学指标与病理的相关性。【方法】对 191例各种类型慢性肝病患者联合检测透明质酸(HA)、血清Ⅲ型前胶原 (PCⅢ )、Ⅳ型胶原 (Ⅳ C) ,同时行肝组织学检查 ,进行对照研究。【结果】血清HA水平随肝组织病理纤维化分期而升高 ,在S4 期最高 ,与各期比较差异有显著性 (P <0 0 1) ,与肝组织病理纤维化分期有相关性 (r =0 377,P=0 0 0 1) ;血清PCⅢ、Ⅳ C水平在肝组织病理纤维化分期各期中无差异 (P >0 0 5 ) ;血清HA、Ⅳ C水平随组织病理炎症活动度分级而升高 ,在G4 时最高 ,与各级比较差异有显著性 (P <0 0 5 ) ;而各级血清PCⅢ水平无差异 (P >0 0 5 )。【结论】血清HA水平与肝组织病理学的分级和分期的相关性较好 ,可作为一种无创伤的肝纤维化诊断指标 ,而血清PCⅢ、Ⅳ C水平与肝组织病理学的分级和分期的相关性不明显 ,对肝纤维化诊断的意义还需进一步研究。

Objective To investigate the relationship between serum markers of liver fibrosis and liver histopathologic changes in patients with chronic hepatitis. Methods The measurement of serum levels of hyaluronic acid (HA)、serum type Ⅲ procollagen (PC Ⅲ) and collagen Ⅳ(Ⅳ-C) was carried out by radioimmunoassay in 191 patients with different chronic hepatic diseases. These levels were compared with the histopathological grading and staging of those patients. Results The serum level of HA was significantly higher in G 4 and S 4 than that in other grading groups and staging groups. The histopathological grading and staging were closely correlated with the serum level of HA. The serum level of PC Ⅲ wasn't significantly increased in accordance with the histopathological grading and staging. The serum level of Ⅳ-C was significantly higher in G 4 than that in other grading groups and was closely correlated with the histopathological grading but not with the staging. Conclusions HA serum levels is found to be a useful marker of the liver fibrosis. PC Ⅲ and Ⅳ-C are not related to the staging of the liver fibrosis. Thus PC Ⅲ and Ⅳ-C can not be used as substitutes for liver biopsy in diagnosis of liver fibrosis.