肝功能指标及肝纤维化标志物在乙型肝炎患者中的测定意义研究

Significance of determination of liver function indexes and liver fibrosis markers in differential diagnosis of patients with hepatitis B

目的探讨肝功能指标高尔基蛋白73(GP73)、甲胎蛋白(AFP)、甲胎蛋白异质体3(AFP-L3)和肝纤维化标志物Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)、甘胆酸(CG)、血清透明质酸(HA)、层粘蛋白(LN)在乙型肝炎的测定价值,旨在为临床乙型肝炎的诊断提供参考依据。方法选取医院2015年6月-2016年6月接诊127例肝病患者,根据患者所患疾病不同,分为四组,其中50例慢性乙型肝炎患者设为慢性肝炎组和22例急性肝炎患者设为急性肝炎组;另选取23例肝癌患者设为肝癌组、32例肝硬化患者设为肝硬化组;比较四组患者入院时,入院24h和入院48h的肝功能、肝纤维化标志物的表达差异。结果不同时间节点慢性肝炎组GP73、PCⅢ、Ⅳ-C、CG表达量均显著低于急性肝炎组(P<0.05);慢性肝炎组PCⅢ、Ⅳ-C、GP73、HA、CG、LN显著低于肝硬化组(P<0.05),慢性肝炎组AFP、GP73、LN、PCⅢ、Ⅳ-C、HA、AFP-L3显著低于肝癌组(P<0.05),急性肝炎组CG显著高于肝癌组,AFP、AFP-L3、HA、LN显著低于肝癌组(P<0.05),急性肝炎组AFP显著高于肝硬化组,GP73、AFP-L3、HA、LN显著低于肝硬化组(P<0.05),肝癌组GP73、CG、HA显著低于肝硬化组,AFP、AFP-L3显著高于肝硬化组(P<0.05)。结论 GP73、AFP、AFP-L3、CG、HA、PCⅢ、Ⅳ-C、LN的表达在乙型肝炎的鉴别与诊断中有一定研究意义,可提高乙型肝炎的早期诊断率,对患者病情控制及治疗有良性影响。

OBJECTIVE To explore the value of determination of liver function indexes Golgi protein 73（GP73）,alpha-fetoprotein（AFP）,and alpha-alpha protein isoform 3（AFP-L3）as well as liver fibrosis markers typeⅢ procollagen（PCⅢ）,type IV collagen（IV-C）,glycolic acid（CG）,serum hyaluronic acid（HA）,and laminin（LN）in diagnosis of hepatitis B so as to provide guidance for clinical diagnosis of hepatitis B.METHODS A total of 127 patients with liver diseases who were treated in the hospital from Jun 2015 to Jun 2016 were enrolled in the study and were divided into four groups according to the types of diseases,50 patients with chronic hepatitis B were assigned as the chronic hepatitis group,22 patients with acute hepatitis were set as the acute hepatitis group,23 patients with liver cancer were assigned as the liver cancer group,and 32 patients with liver cirrhosis were set as the liver cirrhosis group.The liver function indexes and levels of expression of liver fibrosis markers were observed and compared among the four groups at the admission and after the admission for 24 and 48hours.RESULTS The levels of expression of GP73,PCⅢ,Ⅳ-C,and CG of the chronic hepatitis group were significantly lower than those of the acute hepatitis group at different time points（P〈0.05）.The levels of PCⅢ,Ⅳ-C,GP73,HA,CG,and LN of the chronic hepatitis group were significantly lower than those of the liver cirrhosis group（P〈0.05）;the levels of AFP,GP73,LN,PCⅢ,Ⅳ-C,HA,and AFP-L3 of the chronic hepatitis group were significantly lower than those of the liver cancer group（P〈0.05）;the CG level of the acute hepatitis group was significantly higher than that of the liver cancer group;the levels of AFP,AFP-L3,HA,and LN of the acute hepatitis group were significantly lower than those of the liver cancer group（P〈0.05）;the AFP level of the acute hepatitis group was higher than that of the liver cirrhosis group;the levels of GP73,AFP-L3,HA,and LN of the acute hepatitis group were significantly lower than those of the liver cirrhosis group（P〈0.05）.The levels of GP73,CG,and HA of the liver cancer group were lower than those of the liver cirrhosis group;the levels of AFP and AFP-L3 of the liver cancer group were significantly higher than those of the liver cirrhosis group（P〈0.05）.CONCLUSION The expression of GP73,AFP,AFP-L3,CG,HA,PCⅢ,Ⅳ-C,or LN has certain significance in differential diagnosis of hepatitis B and can raise the rate of early diagnosis of hepatitis B,and it has favorable effect on control and treatment of illness condition.