日本血吸虫病患者血清肝纤四项检测临床诊断价值的研究

Study on the clinical usefulness of the serum fibrosis index to diagnose hepatic fibrosis in patients with schistosomiasis

目的探讨血清肝纤维化四项(肝纤四项)在诊断日本血吸虫病肝实质损害的程度及其临床意义。方法采用放射免疫分析法检测鄱阳湖区3个血吸虫病流行县的晚期和慢性血吸虫病(分别简称晚血和慢血)患者及健康对照人群血清肝纤四项标志物,同时采用酶联免疫吸附试验(ELISA)测定乙肝二对半,对检测结果进行统计学分析。结果检查晚血、慢血患者以及健康者人数分别为109例、189例和30例,晚血组和慢血组的血清肝纤四项平均水平差异均有统计学意义(tHA=12.469,tPCⅢ=19.553,tⅣ-C=10.997,tLN=16.973,P均<0.01);单纯慢血组与健康组比较,HA水平差异有统计学意义(t=5.168,P=0.043);分别将肝纤四项阳性的健康者和阳性的血吸虫病患者赋值为0和1后进行分析;单纯晚血组HA和LN水平均呈弱一致性(KHA=0.357,KLN=0.236,P<0.01),但"联合诊断"呈中度一致性(K=0.562,P<0.01),单纯慢血组中只有"联合诊断"呈弱一致性(K=0.333,P<0.01);单纯晚血组和单纯慢血组的敏感度(Se晚=91.6,Se慢=80.0)和Younden指数(YI晚=53.6,YI慢=42.1)以"联合诊断"为各组最高,ROC曲线下面积以LN为最高(ROC晚=0.740,ROC慢=0.673),"联合诊断"次之(ROC晚=0.677,ROC慢=0.619)。结论 HA检测有助于血吸虫病早期诊断,而对血吸虫病患者进行肝纤四项联合检测,有助于提高血吸虫病肝纤维化诊断的准确性与敏感性,同时能区别晚血和慢血。

Objective To explore the clinical usefulness of the serum fibrosis index in diagnosing damage to the liver parenchyma in patients with schistosomiasis. Methods A radioimmunoassay was performed on sera from patients with advanced and chronic schistosomiasis from 3counties in the Poyang Lake region where Schistosoma japonica is endemic.The fibrosis index was determined by combining procollagen Ⅲ（PCⅢ）,laminin（LN）,hyaluronidase（HA）,and collagen typeⅣ（Ⅳ-C）.Antibodies to and antigens of hepatitis B were detected with ELISA kits. Results One hundred and nine patients with advanced schistosomiasis,189 with chronic schistosomiasis,and 30 healthy controls were examined.The mean components of the fibrosis index in patients with advanced schistosomiasis（group A）and patients with chronic schistosomiasis（group C）differed significantly（tHA=12.469,tPCⅢ=19.553,tⅣ-C=10.997,tLN=16.973;P〈0.01 for all）.The HA level in patients with chronic schistosomiasis differed significantly from that in the healthy control group（t=5.168,P=0.043）.For analysis,healthy individuals were assigned a fibrosis index of 0and patients with chronic schistosomiasis were assigned a fibrosis index of 1.The levels of HA and LN weakly coincided in patients with advanced schistosomiasis（KHA=0.357,KLN=0.236,P〈0.01）but moderately coincided in patients with a combined diagnosis（K=0.562,P〈0.01）.In patients with chronic schistosomiasis,levels of HA and LN weakly coincided with a combined diagnosis（K=0.333,P〈0.01）.The sensitivity（Se晚 =91.6,Se慢 =80.0）and the Younden index（YI晚 =53.6,YI慢 =42.1）of a combined diagnosis were highest for patients with advanced or chronic schistosomiasis.The area under the ROC curve of LN was highest（ROC晚 =0.740,ROC慢 =0.673）,followed by a combined diagnosis（ROC晚 =0.677,ROC慢 =0.619）. Conclusion The detection of HA is helpful for diagnosis of schistosomiasis in the early stages of infection.Combined determination of 4components of the liver fibrosis index can improve the sensitivity and specificity of schistosomiasis diagnosis and can distinguish advanced and chronic schistosomiasis as well.