血清肝纤维化指标联合肝生化检测对乙肝患者肝纤维化的评估

The Value of Serum Fibrosis Indexes Combined with Liver Function Tests in the Evaluation of Hepatic Fibrosis in Patients with Hepatitis B

目的:研究血清肝纤维化指标联合乙型肝炎病毒(HBV)检测对乙肝患者肝纤维化的评估。方法:选择2015年1月至2016年12月广州华银医学检验中心进行检测的临床诊断为单纯乙肝患者45例和乙肝并发肝硬化患者42例作为研究对象,并选取35例体检正常者作为对照组。比较3组研究对象的透明质酸(HA)、人Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)水平等变化情况。结果:单纯乙肝组、乙肝并发肝硬化组患者的HA、PCⅢ、LN和Ⅳ-C等血清肝纤维化指标均明显高于正常对照组,且乙肝并发肝硬化组患者的上述血清肝纤维化指标显著高于单纯乙肝组(P<0.05);单纯乙肝组按病理学结果分层后轻度与中度患者的HA、PCⅢ、LN和Ⅳ-C等指标均显著低于重度组(P<0.05);单纯乙肝组重度患者与乙肝并发肝硬化组患者的4项血清肝纤维化指标比较差异均无统计学意义(P>0.05)。单纯乙肝组按ALT分层后,400<ALT≤800 IU/L的患者HA、PCⅢ、LN和Ⅳ-C水平显著低于乙肝并发肝硬化组,ALT>1 200 IU/L的患者HA、PCⅢ、LN和Ⅳ-C水平显著高于乙肝并发肝硬化组(P<0.05)。结论:HA、PCⅢ、LN和Ⅳ-C等肝纤维化指标联合肝功能检测可以反映乙肝患者肝纤维化的进展情况,对预防肝硬化有指导意义。

Objective：To investigate the value of serum fibrosis indexes combined with liver function tests in the evaluation of hepatic fibrosis in patients with hepatitis B. Methods：A total of 45 patients with hepatitis B and 42 patients with hepatitis B and liver cirrhosis who were detected in our center from Jan 2015 to Dec 2016 were selected as subjects,and 35 normal subjects were selected as controls. The serum liver fibrosis indexes such as hyaluronic acid（HA）,type Ⅲ procollagen（PCⅢ）,laminin（LN）and type Ⅳ collagen（Ⅳ-C）were compared among the 3 groups. Results：The levels of HA,PCⅢ,LN and Ⅳ-C in hepatitis B group and hepatitis B/cirrhosis group were significantly higher than those in control group（P〈0.05）. And the levels of these indexes in hepatitis B /cirrhosis group were also significantly higher than those in hepatitis B group（P〈0.05）. The levels of HA,PCⅢ,LN and Ⅳ-C were not significantly different between mild and moderate hepatitis B patients（P〉0.05）. However,the levels of these indexes in mild and moderate hepatitis B patients were significantly lower than those in severe patients（P〈0.05）. There was no significant difference in serum hepatic fibrosis indexes between severe hepatitis B group and hepatitis B /cirrhosis group（P〉0.05）. In the hepatitis B group,the levels of HA,PCⅢ,LN,and Ⅳ-C in patients with 400 〈ALT ≤ 800 IU/L were significantly lower than those in hepatitis B/cirrhosis group,and the levels of these indexes in patients with ALT〉1 200 IU/L were significantly higher than those in hepatitis B /cirrhosis group（P〈0.05）. Conclusion：The hepatic fibrosis indexes such as HA,PCⅢ,LN and Ⅳ-C combined with liver function tests can reflect the progress of hepatic fibrosis in hepatitis B patients with and have guiding significance for the prevention of cirrhosis.