细胞外基质因子检测对肝纤维化早期诊断的预测价值

The Study of the Combination Detection of Some Extra Cellular Matrixes in the Diagnosis of Liver Fibrosis

目的 :通过对多种细胞外基质因子的检测 ,创建出一套无创、简便易行的诊断肝纤维化的方法。方法 :以肝活检为肝纤维化诊断的金标准 ,同时检测肝纤维化和正常对照者血清中的透明质酸、层黏连蛋白、纤黏连蛋白、血清IV型胶原、血清III型前胶原氨基端肽和血清脯氨酸肽酶 ,并采用多元Logistic回归分析建立诊断方程。结果 :肝硬化组和慢性乙型肝炎 (重度 )以上各指标均无显著差别 ,慢性乙型肝炎 (重度 ) >慢性乙型肝炎 (中度、轻度 ) >正常对照。透明质酸、层黏连蛋白、血清IV型胶原、血清III型前胶原氨基端肽和血清脯氨酸肽酶各因素均进入回归方程。以回归方程预测的肝纤维化T值大于 0 .95者做判断肝纤维化的标准 ,结果该法诊断的灵敏度和特异度分别为 86 .7%和 80 .0 % ,符合率为 85 %。结论 :肝细胞基质透明质酸、层黏连蛋白、纤黏连蛋白、血清IV型胶原、血清III型前胶原氨基端肽和血清脯氨酸肽酶是诊断肝纤维化的敏感指标 。

Objective: To build formula of model in the diagnosis of liver fibrosis by combination detection of some extra cellular matrixes. Methods: Liver biopsy and pathology were used as golden standard of liver fibrosis diagnosis. Serum fibrosis markers of liver fibrosis group and normal control group were detected. Logistic regression analysis, was used to build diagnostic equation. Results: There was no difference between liver cirrhosis and severe chronic hepatitis B ( P <0.05),but there was a significant difference among severe and moderate chronic hepatitis B and normal control. The regression equation of some parameters was established, the sensitivity and specificity of regression evaluaity diagnosis liver fibrosis were 86.7% and 80.0% respectively. Conclusion: The combination of noninvasive parameters is more valuable than single parameter in the diagnosis of liver fibrosis, and building regression evaluation by detecting extra cellular matrixes may predict liver fibrosis.