摘要
目的 研究肝纤维化血清学指标与慢性肝病患者肝穿剌活体组织学检查纤维化分期的量化关 系。方法 用放射免疫法检测118例肝病患者血清层黏连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原蛋白 (PCⅢ)、Ⅳ型胶原蛋白(CⅣ)的水平，并与患者的肝组织病理学检查作对比。通过 SPSS 11．0软件包分析 LN、HA、PCⅢ、CⅣ与肝组织纤维化分期及炎症分级的量化关系。结果 LN、HA、PCⅢ、CⅣ与肝组 织学炎症分级有相关性(r 分别为0．394、0．449、0．443、0．351，P 值均＜0．01)；与用组织纤维化分期也有相 关件(r 值分别为0．456、0．564、0．476、0．421，P 值均＜0．01)。LN、HA、PCⅢ、CⅣ对 S2以卜肝纤维化诊断 界值分别为110、110、100、70 ng/ml，其诊断灵敏度分别为70%，79%、79%、74%，特异度分别为68%、72%、 64%、73%。对 S4(早期肝硬化)的诊断界值分别为130、140、120、70 ng/ml，基诊断灵敏度分别为79%、 93%、79%、86%，特异度分别为66%、82%、72%、61%。受试者工作特征曲线分析显示：在这些患者中判 断有无肝硬化存在，HA 比其它指标更有价值；HA 测定值大于190 ng/ml 时，其诊断早期肝硬化的准确度 为93%。结论 慢性肝病患者，血清 HA、LN、PCⅢ、CⅣ水平与肝纤维化分期有一定量化关系，其中 HA 诊断早期肝硬化有重要意义。
Objectives To study the quantitative relationship between the levels of serum liver fibrosis markers and fibrosis stages of liver tissues in patients with chronic hepatic diseases. Methods In 118 patients with chronic hepatitis, fatty liver or cirrhosis, their Serum levels of LN, HA, PCIII and CIV were investigated by EIA and their liver histological changes were studied. The relationship between the levels of serum LN, HA, PCⅢ and CⅣ and the degrees of liver tissue fibrosis was analyzed quantitatively by using SPSS 11.0. Results A correlation between the levels of serum LN, HA, PCⅢ and CⅣ and the histologically assessed grades of inflammatory activity was found （r = 0.394, 0.449, 0.443, 0.351, respectively, P 〈 0.01）. The correlations between the levels of serum LN, HA, PCⅢ and CⅣand the histologically assessed stages of liver fibrosis were strong （r= 0.456, 0.564, 0.476, 0.421 respectively, P 〈0.01）. The levels of serum LN, HA, PCⅢ and CⅣ of the patients with a stage 2 liver fibrosis were 110 ng/ml, 110 ng/ml, 100 ng/ml and 70 ng/ml respectively, with sensibilities of diagnosing stage 2 liver fibrosis at 70%, 79%, 79% and 74% respectively. Their specificities in diagnosing stage 2 liver fibrosis were 68%, 72%, 64% and 73% respectively. The levels of LN, HA, PCⅢ and CⅣ in serum of these patients diagnosing cut-off value in stage 4 liver fibrosis （early cirrhosis） were 130 ng/ml, 140 ng/ml, 120 ng/ml and 70 ng/ml respectively. Their sensibility of diagnosing liver cirrhosis was 79%, 93%, 79% and 86% respectively. Their specificity of diagnosing liver cirrhosis was 66%, 82%, 72% and 61% respectively. As shown by the ROC curves in these patients, differentiating patients with cirrhosis or without cirrhosis, serum HA level was more valuable than LN, PCⅢ, CⅣ （the areas under the curves = 0.938 vs 0.775, 0.787, 0.791 ） When serum HA was higher than 190 ng/ml, the veracity of diagnosing liver cirrhosis was 93%. Conclusions There is a certain quantitative relationship between the levels of LN, HA, PCⅢ and CⅣ in serum and the degrees of liver tissue fibrosis. The level of HA in serum is an important reference datum for early diagnosis of liver cirrhosis.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2005年第12期911-914,共4页
Chinese Journal of Hepatology
