血清纤维化指标的影响因素分析

Study on the influence factors of the serum flbrosis markers

目的 探讨慢性乙型肝炎恢复期患者血清纤维化4项指标[血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CIV)和层黏连蛋白(LN)]的影响因素及意义。方法用放射免疫法检测141例慢性乙型肝炎患者血清HA、PCⅢ、LN、CⅣ,并将他们分为不一致组和一致组。肝活检标本行常规病理检查,自动生物化学分析仪检测肝功能,B超检查肝门静脉主干内径、脾门部脾静脉内径及腋中线处脾脏厚度。结果血清纤维化指标与肝纤维化程度不一致患者16例(14.16％),血清纤维化指标不一致的产生与肝纤维化程度分期无关,与肝脏炎症活动度有关(X2=12.07,P<0.05)。不一致组患者血清丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰基转移酶、球蛋白水平明显下降,分别从89.28±64.25、66.10±42.30、86.26±70.36、32.13±5.18下降至49.31±26.75(t=2.45,P<0.05)、40.83±22.40(t=2.33,P<0.05)、48.99±29.96(t=2.08,P<0.05)、28.05±3.47(t=3.03,P<0.01)。白蛋白和白蛋白/球蛋白比值则明显升高,分别从42.34±4.81、1.35±0.28上升至46.19±3.61(t=3.06,P<0.01)、1.63±0.26(t=3.70,P<0.01)。血清碱性磷酸酶、总胆红素、总蛋白无明显改变,肝门静脉主干内径、脾门部脾静脉内径及腋中线处脾脏厚度也无明显改变。结论

Objective To analyse the factors which influence the four serum fibrosis markers hyaluronic acid (HA), type III procollagen (PCIE), laminin (LN) and type IV collagen (CIV). Methods The levels of serum HA, PCIII, LN and CIV were measured by RIA in 141 patients with chronic hepatitis B (CHB), then the patients were divided into two groups according to the serum fibrosis markers, namely consistent group and inconsistent group, the liver biopsy materials were examined pathomorphologically and liver function was detected by automatic biochemistry analyzer, The interior diameters of the portal vein, the spleen vein and the thickness of the spleen were also measured with ultrasonography. Results 16 patients (14.16%) whose serum fibrosis markers were inconsistent with histological stage of liver fibrosis were found. Their serum fibrosis markers were not correlated with staging of liver fibrosis (P>0.05), but were positively correlated with inflammation grade ( x2=12.07, P<0.05), at same time, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase(AST), gamma-glutamyltransferase (GGT) and globulin (GLB) decreased obviously, from 89.28 U/L + 64.25 U/L to 49.31 U/L + 26.75 U/L (t=2.45, P<0.05), 66.10 U/L + 42.30U/L to 40.83 U/L + 22.40U/L (t=2.33, P<0.05), 86.26U/L + 70.36U/L to 48.99 U/L +29.96U/L (t=2.08, P<0.05) and 32.13 g/L+5.18 g/L to 28.05 g/L+ 3.47g/L (t=3.03, P<0.01) respectively. And the level of albumin (ALB) and the ratio of albumin and globulin (A/G) increased evidently, from 42.34 g/L +4.81 g/L to 46.19g/L+3.61 g/L (t=3.06, P<0.01) and 1.35 + 0.28 to 1.63 +0.26 (t=3.70, P<0.01). But the serum level of alkaline phosphatase (ALP), total bilirubin (TBil), total protein (TP), the width of main portal vein, the width of splenic vein and the thickness of the spleen did not change clearly (P>0.05). Conclusions As diagnostic markers, serum fibrosis markers as well as inflammation grade and liver function should be taken into account.