肝纤维化血清学指标检测在病毒性肝炎肝纤维化诊断中的价值  

The Study on Serologic Index of Hepatic Fibrosis in Viral Hepatitis

作　　者：杨顺[1] 肖燕[1] 林军[1] 杨欢[1] 朱雪明[1] 

机构地区：[1]苏州大学附属第二医院检验科,江苏苏州215004

出　　处：《苏州大学学报（医学版）》2008年第3期430-432,共3页Suzhou University Journal of Medical Science

摘　　要：目的探讨血清中透明质酸(HA)、N-乙酰-β-D-葡萄糖苷酶(NAG)、由凝血酶原时间(PT)、γ-谷氨酰转肽酶(GGT)、载脂蛋白A1(Apo-A1)组成的PGA指数、Ⅲ型前胶原氨基端肽(PⅢNP)、Ⅳ型胶原(C-Ⅳ)及层粘连蛋白(LN)的测定在肝纤维化诊断中的应用价值。方法选取217例处于不同炎症进展期的病毒性肝炎患者(包括82例肝穿刺患者)的标本,采用放射免疫法(RIA)检测血清中的HA、PⅢNP、C-Ⅳ、LN;用全自动生化分析仪测定血清NAG、PGA指数。结果HA、NAG、PGA指数在肝炎各组及肝硬化组不同病理分期的差异均有统计学意义(P<0.05);PⅢNP、C-Ⅳ在肝硬化S2￣S3期间的差异无统计学意义(P>0.05);LN在炎症不同时期及肝纤维化的不同病理分期差异均无统计学意义(P>0.05)。结论(1)HA、NAG、PGA指数的联合检测有助于肝纤维化的临床诊断和对抗纤维化的疗效监测;(2)PⅢNP、C-Ⅳ在慢性肝炎轻度和重度的鉴别诊断中有重要意义,但对监测肝纤维化演变过程缺乏显著的特异性。Objective To explore the applicable value of hyaluronic acid （HA）, collagen type Ⅳ（C-IV）, N-terminal procollagen Ⅲ（PⅢNP）, laminin （LN）, NAG and the PGA ratio （PT/GGT/Apo- A1） in the detection of diagnosis of liver fibrosis. Methods Serum markers were studied in 217 patients （contain 82 pathologies） with viral hepatitis：（1）HA,C-Ⅳ,PⅢNP,LN were determined by radio-immunoassay. （2）NAG and PGA ratio were determined by biochemical auto-analyzer. Results （1）Serum HA, NAG and PGA ratio elevated significantly with the progress of inflammation and fibrosis（P〈0.05）. （2）Serum PⅢNP, C-Ⅳ increased with the progress of inflammatory severity but no significant change was observed between S2-S3 fibrotic grades. （3）Serum LN remained unchanged in different histological grades, therefore it was not able to reflect the progress of inflammation and liver fibrosis. Conclusions （1）Co-detection of serum HA, NAG and PGA ratio provides accurate and reliable indexes for the clinical diagnosis. Dynamic observation of their changes may be used to know the progress of disease and be used as reliable indexes to judge the therapeutic effect of antifibrotic drugs. （2）To some extent it is important to differentiate middle hepatitis from mild hepatitis of serum PⅢNP and C-Ⅳ, therefore these serum markers may be taken as indexes to reflect levels of hepatitis severity.

关 键 词：透明质酸 Ⅲ型前胶原氨基端肽 Ⅳ型胶原 层粘连蛋白 N-乙酰-β—D-葡萄糖苷酶 PGA指数 肝纤维化 

分 类 号：R512.604[医药卫生—内科学]