血、尿、腹水Ⅲ型前胶原肽联合检测在肝脏疾病中的临床价值

Combined Determination of Type Ⅲ Procollagen in Blood, Urine, and Ascite in Patients with Hepatic Disease

目的 :探讨血 ,尿 ,腹水 型前胶原肽 (P P)联合检测在肝脏疾病中的临床价值。方法 :采用放射免疫法同步测定 6 0例慢性乙型肝炎、肝炎后肝硬化、肝功能失代偿患者血、尿、腹水中 P P含量变化 ,同时进行血清 P P含量与转氨酶、血清总胆红素含量、血清白蛋白的相关性测定。正常对照组中血 41例 ,尿 40例 ,均选自我院健康献血员 ;腹水 31例选自我院肾内科肾源性腹水患者。结果 :肝硬化患者血、尿、腹水中 P P含量均明显高于对照组 ,差异显著 ,腹水中 P P含量明显高于血清及尿中 P P含量 ,P <0 .0 0 1;以 130μg/ L为临界值 ,计算其 95 %可信区间内其 P P敏感性、特异性、准确性均为腹水 >血 >尿 ;血清 P P含量与转氨酶、血清总胆红素含量呈正相关 ,与血清白蛋白呈负相关 ,差异显著 ,P <0 .0 5。结论 :慢性乙型肝炎 ,肝炎后肝硬化患者无论血、尿、腹水中 P P检测均可获得较高的敏感性和特异性。 P P含量测定对诊断肝纤维化有一定的价值 ,其血清含量变化在反映肝硬化、肝细胞坏死及肝功能损害程度方面具有一定的临床实用价值。

Objective: Our aim was to investigate the value of combined N terminal peptide of type Ⅲ procollagen( PⅢP )content assay in blood, urine, and ascite in patients with hepatic diseases. Methods: We investigatied the PⅢP content in blood, urine, and ascite from patients with chronic active hepatitis and posthepatic cirrhosis with radioimmunoassay. Simultaneously, the levels of serum albumin, alanline aminoacyltransferase (ALT), and total bilirubin (T BIL ) were determined. The control group included 41 blood samples and 40 urine samples from healthy blood donors; 31 ascite samples from patients at nephrology ward. Results: The PⅢP content of patients with cirrhosis was higher than that of the control group (P<0.001). In cirrhosis patients, the PⅢP content in ascite was higher than that in blood and urine. Given 130 μg/L as critical value, the sensitivity, specificity, and accuracy of PⅢP content ranged from high to low as follows: ascite, blood, urine. The serum content of PⅢP positively relatied with ALT, T BIL, and negatively related with albumin (P< 0.05). Conclusion: The investigation of PⅢP content not only is valuable for diagnosis of hepatic fibrosis, but also can reflect the degree of hepatocyte necrosis and impairment of liver function.