肝纤维化血清五项标志物的诊断意义  

Diagnostic value of five serum markers for liver fibrosis

作　　者：罗瑞虹[1] 杨绍基[1] 谢俊强[1] 赵志新[1] 何有成[1] 姚集鲁[1] 

机构地区：[1]中山医科大学附属第三医院传染病科,广州510630

出　　处：《中华肝脏病杂志》2001年第3期148-150,共3页Chinese Journal of Hepatology

摘　　要：目的 探讨慢性肝炎患者血清透明质酸（ＨＡ）、 Ⅲ型前胶原（ＰＣ Ⅲ）、Ⅳ型胶原（Ｃ Ⅳ）、层粘蛋白（ＬＮ）和转化生长因子 β１（ＴＧβ１）对肝纤维化的诊断意义。方法检测 １１６例病毒性肝炎患者血清 ＨＡ、 ＰＣⅢ、 Ｃ Ⅳ、 ＬＮ、 ＴＧＦ β１水平，并与其中 ８７例慢性肝炎患者的肝组织病理作对比。结果血清 ＨＡ与肝组织炎症活动度呈较弱的正相关（ｒ＝０．３９３， Ｐ＜０．０５），血清 ＨＡ、 ＰＣ Ⅲ、 ＬＮ、 ＴＧＦ β１与肝纤维化程度呈中等程度的正相关（ｒ分别为 ０．５８４、 ０．４５４、 ０．４４１和 ０．６１２， Ｐ＜ ０．０５），血清 Ｃ Ⅳ与之则呈较弱的正相关（ｒ＝０．３１９， Ｐ＜ ０．０５）。血清 ＨＡ诊断肝硬化的 ＡＵＣ明显大于血清ＰＣⅢ、 Ｃ Ⅳ、 ＬＮ、 ＴＧＦ β１者（ＡＵＣ＝０．９０４ ｖｓ ０．７８４、 ０．８１５、 ０．８０５、０．８２８， Ｐ＜ ０．０５）；血清 ＨＡ、 ＬＮ、 ＴＧＦ β１判断Ｓ２期以上肝纤维化的 ＲＯＣ曲线下面积（ＡＵＣ）明显大于血清ＰＣ Ⅲ、 Ｃ Ⅳ者（ＡＵＣ＝０．８４９、 ０．８１９、 ０．８３６ ｖｓ ０．７０２、 ０．７２１， Ｐ＜ ０．０５）。联合五项指标估计肝纤维化程度，判别分析只选入血清 ＨＡ和Objective To research the diagnostic value of serum hyaluronic acid (HA), type Ⅲ procollagen (PC Ⅲ ), type IV collagen (CIV), laminin (LN), and transforming growth factor β 1 (TGF β１) for liver fibrosis in patients with chronic hepatitis. Methods Serum levels of HA, PC Ⅲ , C IV, LN and TGF β 1 in 116 patients with chronic hepatitis and cirrhosis were investigated and compared with hepatic histological findings of 87 patients. Results The correlation between serum HA and histologically assessed grade of inflammatory activity was weak (r=0.393, P<0.05). The correlation between serum HA, PC Ⅲ, LN, TGF β 1 and histologically assessed stage of liver fibrosis were all moderate (r=0.584, 0.454, 0.441 and 0.612, respectively, P<0.05), while that between serum C IV and histologically assessed stage of liver fibrosis was weak (r=0.319, P<0.05). As shown by the ROC curves in cases of chronic hepatitis, the ability to differentiate patients with cirrhosis from those without cirrhosis was greater for serum HA than that for serum PC Ⅲ , C IV, LN, and TGF β 1 (the areas under the curves=0.904 vs 0.784, 0.815, 0.805, 0.828, P<0.05). The ability of serum HA, LN and TGFβ1 to differentiate patients with extensive liver fibrosis from those with no or mild liver fibrosis exceeded that of serum PCⅢ and C IV(the areas under the curves=0.849, 0.819, 0.836 vs 0.702, 0.721, P<0.05). To discriminate the stage of liver fibrosis, serum HA and TGF 1 were selected from the five markers by Bayes discriminate analysis. If S1, S2 and S3 were not required to be discriminated, discrimination between the three stages showed significant difference (P<0.05). The predictive accurate percentage was 72.90%. Conclusions The five markers all have the ability not only to judge liver cirrhosis, in which the ability of serum HA is the best, but also to differentiate chronic hepatitis with extensive liver fibrosis from that with no or mild liver fibrosis, in which the ability of serum HA, LN, TGFβ1 is stronger than the other

关 键 词：肝纤维化 透明质酸 Ⅳ型胶原 转化生长因子Β1 层粘蛋白 血清诊断 

分 类 号：R575.2[医药卫生—消化系统]