肝纤维化血清标志物联合分析与病理诊断的关系  

Relationship between Four Serum Fibrosis Markers and Histopathology in Chronic Viral Hepatitis

作　　者：陈金国[1] 柴明胜[1] 张新麟 张宝珍[3] 孔宪涛[4] 

机构地区：[1]海军医学研究所,上海市200433 [2]济宁市传染病医院 [3]上海市传染病医院 [4]第二军医大学长征医院

出　　处：《海军医学杂志》2000年第1期26-29,共4页Journal of Navy Medicine

摘　　要：目的 :探讨肝纤维化血清标志物水平与病理纤维化分期的关系。方法 :病毒性肝炎患者 83例 ,测定其血清透明质酸 (HA)、层粘连蛋白 (LN)、Ⅲ型前胶原 (PCⅢ )和Ⅳ型胶原 (Ⅳ -C)含量 ,其中 6 2例同时作肝组织病理检查。结果 :四项指标多随着慢性肝炎严重程度同步升高 ,与病理纤维化相关性依次为HA >PCⅢ >LN >Ⅳ -C ,但S1期升高均不显著。联合检测HA与Ⅳ -C对慢性肝炎中度或S2期纤维化最有意义 ;而判断S4期纤维化的最适组合为HA +PCⅢ +LN。结论 :血清纤维化标志物与病理纤维化分期显著相关 ,联合测定对肝纤维化、肝硬化有较好的诊断价值。Aim: To explore the clinical significance of serum fibrosis markers evaluated by histopathological findings. Methods: Serum levels of hyaluronan (HA), laminin(LN), type Ⅲ procollagen (PCⅢ) and type Ⅳ collagen(Ⅳ C) were assayed in 83 patients with viral hepatitis and liver biopsy was carried out in 62 of them. Results: The four markers were significantly elevated in all types of chronic hepatitis (moderate, severe/S2 S4) and cirrhosis except that with S1 fibrosis. The levels of all markers except Ⅳ C were gradually increased with histopathological fibrosis staging of chronic hepatitis. A more significant correlation was observed between fibrosis scores and serum HA levels (r=0.614) than those between fibrosis scores and PC Ⅲ(r=0.469) or LN (r=0.437,P<0.01) or Ⅳ C (r=0.253, P>0.05) levels. Among combination assays, the co detection of HA, LN and PCⅢ had the greatest significance for diagnosis of S4 fibrosis with sensitivity of 62.5% and specificity of 93.3%. Conclusion: Serum HA, LN, PCⅢ and Ⅳ C levels and pathological hepatic fibrosis staging were correlated significantly. Co determination was useful in monitoring liver fibrosis and cirrhosis.

关 键 词：肝纤维化 肝硬化 标志物 胶原 诊断 

分 类 号：R575.204[医药卫生—消化系统]