血清肝纤四项与肝功能联合检测评估慢性乙肝患者肝纤维化程度的价值

Value of Combined Detection of Four Items of Serum Liver Fibrosis and Liver Function on Evaluating the Liver Fibrosis Degree in Patients with Chronic Hepatitis B

目的:探究血清肝纤四项与肝功能联合检测评估慢性乙肝患者肝纤维化程度的价值。方法:回顾性分析2022年1月-2023年1月赣州市赣县区人民医院收治的116例慢性乙肝经穿刺确诊肝纤维化的患者的临床资料,根据其肝纤维化分期分为S1组(n=27)、S2组(n=39)、S3组(n=29)、S4组(n=21)。比较不同分期肝纤维化患者血清肝纤维四项水平[透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、层粘连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)]、肝功能指标水平[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、总胆汁酸(TBA)、白蛋白(ALB)、血小板计数(PLT)]。以Spearman相关性分析模型分析血清肝纤四项、肝功能与慢性乙肝合并肝纤维化患者肝纤维化程度的相关性。以病理检查结果为“金标准”,统计血清肝纤维四项与肝功能指标联合检测肝纤维化阳性检出率。结果:S1组的HA、Ⅳ-C、LN、PC-Ⅲ、ALT、AST、TBIL、TBA水平均低于S2组、S3组、S4组,且S2组均低于S3组、S4组,S3组均低于S4组(P<0.05)。S1组的ALB水平均高于S2组、S3组、S4组,且S2组均高于S3组、S4组,S3组高于S4组(P<0.05)。S1组的PLT水平高于S2组,但差异无统计学意义(P>0.05)。S1组的PLT水平均高于S3组、S4组(P<0.05)。S2组PLT水平均高于S3组、S4组,S3组高于S4组,但差异均无统计学意义(P>0.05)。经Spearman相关性分析,血清HA、Ⅳ-C、LN、PC-Ⅲ水平和ALT、AST、TBIL、TBA水平与慢性乙肝合并肝纤维化患者肝纤维化程度呈正相关(P<0.05);ALB、PLT水平与慢性乙肝合并肝纤维化患者肝纤维化程度呈负相关(P<0.05)。血清肝纤维四项与肝功能指标联合检测肝纤维化阳性检出率为98.28%(114/116)。结论:慢性乙肝患者予血清肝纤四项与肝功能联合检测对其肝纤维化发生及进展情况具有一定评估作用,有利于肝纤维化早期诊断治疗,具有临床应用价值。

Objective:To explore the value of combined detection of four items of serum liver fibrosis and liver function on evaluating the liver fibrosis degree in patients with chronic hepatitis B.Method:The clinical data of 116 patients with chronic hepatitis B who were diagnosed as liver fibrosis by puncture in Ganxian District People's Hospital,Ganzhou City from January 2022 to January 2023 were retrospective analyzed,according to the liver fibrosis staging,the patients were divided into S1 group(n=27),S2 group(n=39),S3 group(n=29)and S4 group(n=21).Levels of four items of serum liver fiber[hyaluronic acid(HA),typeⅣcollagen(Ⅳ-C),laminin(LN),typeⅢprecollagen(PC-Ⅲ)]and liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),total bile acid(TBA),albumin(ALB),platelet count(PLT)]were compared among patients with different stages of liver fibrosis.Spearman correlation analysis model was used to analyze the correlation between four items of serum liver fibrosis,liver function and liver fibrosis degree in patients with chronic hepatitis B complicated with liver fibrosis.The pathological examination result as the"gold standard",the positive detection rate of liver fibrosis by the combination of four items of serum liver fibrosis and liver function indicators was counted.Result:The levels of HA,Ⅳ-C,LN,PC-Ⅲ,ALT,AST,TBIL and TBA in S1 group were lower than those in S2 group,S3 group and S4 group,those in S2 group were lower than those in S3 group and S4 group,those in S3 group were lower than those in S4 group(P<0.05).ALB level in S1 group was higher than that in S2 group,S3 group and S4 group,that in S2 group was higher than that in S3 group and S4 group,that in S3 group was higher than that in S4 group(P<0.05).PLT level in S1 group was higher than that in S2 group,but the difference was not statistically significant(P>0.05).PLT level in S1 group was higher than that in S3 group and S4 group(P<0.05).PLT level in S2 group was higher than that in S3 group and S4 group,that in S3 group was higher than that in S4 group,but the differences were not statistically significant(P>0.05).According to Spearman correlation analysis,serum levels of HA,Ⅳ-C,LN,PC-Ⅲand ALT,AST,TBIL and TBA were positively correlated with the degree of liver fibrosis in patients with chronic hepatitis B complicated with liver fibrosis(P<0.05).The levels of ALB and PLT were negatively correlated with the degree of liver fibrosis(P<0.05).The positive detection rate of liver fibrosis was 98.28%(114/116)by the combined detection of four items of serum liver fibrosis and liver function.Conclusion:The combined detection of four items of serum liver fibrosis and liver function in patients with chronic hepatitis B has a certain evaluated effect on the occurrence and progression of liver fibrosis,it is conducive to the early diagnosis and treatment of liver fibrosis,and has clinical application value.