慢性肝炎患儿四项血清肝纤维化标志物的检测及其临床意义  

Determination and clinical significance of four serum markers of liver fibrosis in children with chronic hepatitis

作　　者：江冬梅[1] 周均启 张新麟 孙敏[1] 

机构地区：[1]山东济宁市传染病医院检验科,272131

出　　处：《中华儿科杂志》2001年第8期465-468,共4页Chinese Journal of Pediatrics

摘　　要：目的　为了解慢性肝炎患儿血清透明质酸 (HA)、层粘连蛋白 (LN)、Ⅲ型前胶原 (PCⅢ )和Ⅳ型胶原 (cⅣ )的水平及诊断价值。方法　用放射免疫法 (RIA)分 5个年龄组测定 45 9名 1～ 15岁健康儿童和 180名慢性肝炎患儿的 4项肝纤维化标志物。结果　 4项标志物检测结果 ( x±s)如下 :HA(5 8± 16 ) μg/L ,LN(115± 17) μg/L ,PC(146± 2 7) μg/L ,cIV(5 1± 16 ) μg/L。这 4种标志物的正常参考值以 95 %的上限 x +1 6 45s计算 ,分别为HA 85 (5 8+16 ) μg/L ,LN 142 (115 +16 6 ) μg/L ,PC 190 (146+2 7) μg/L ,cIV 77(5 1+16 ) μg/L。HA、cIV与年龄不相关 (r=- 0 0 2 2 ,P >0 0 5 ;r=0 0 70 ,P >0 0 5 ) ,然而LN与年龄显著相关 (r=0 12 82 ,P <0 0 1) ,PC与年龄呈负相关 (r=- 0 6 6 9,P <0 0 1)。慢性表面抗原携带者与同龄对照组差异无显著性。轻度慢性肝炎患儿除HA显著性高于对照组 (P <0 0 5 )外 ,其他 3项均无差异。中度、重度及肝硬化儿童的 4种血清标志物浓度均高于正常对照组 (P <0 0 1)。在中度、重度和肝硬化患儿中 ,有 2种或 2种以上的标志物显著性增加。结论　 4项标志物在儿童期有其年龄特征。它们可反映慢性肝炎患儿肝纤维化的严重程度。因此 ,对慢性肝炎和早期肝硬化的诊?Objective To investigate possible diagnostic value of serum hyaluronic acid (HA), laminin (LN), type III procollagen (PCIII) and type IV collagen (cIV) levels in children with chronic hepatitis Methods The 4 serum markers for liver fibrosis were determined in 459 normal children 1 15 years of age in 5 age groups and 180 childern with chronic hepatitis by using radioimmunoassay (RIA). Results The results of determination of the 4 markers were as follows ( M±s ): HA (58±16) μg/L, LN (115±17 ) μg/L, PCIII (146±27) μg/L and cIV (51±16 ) μg/L The upper limit of 95% normal reference values of the 4 serum markers were calculated as mean value plus 1 645 s, the results of calculation were HA 85 μg/L, 142 μg/L, 190 μg/L and 77 μg/L, respectively No correlation was found between age and HA, cIV ( r =-0 022 1, P >0 05 and r =0 070 8, P >0 05); however, LN significantly correlated with age ( r =0 128 2, P <0 01) and PCIII negatively correlated with age ( r =-0 669, P <0 01) The difference between the values of chronic HBsAg carriers and those of the age matched normal controls was not significant; the values of the mild chronic hepatitis patients were not significantly different from those of the controls except for HA, which was higher than that of the controls ( P <0 05) The serum concentrations of all these markers in children with moderate to severe chronic hepatitis and cirrhosis were significantly increased as compared to those of the normal subjects ( P <0 01) Significant increase of 2 or more markers was seen in 100% of patients with moderate and severe chronic hepatitis and liver cirrhosis. Conclusion The present study demonstrated that the 4 serum markers had certain characteristics with regard to the age of normal children The values of the 4 markers may reflect the severity of chronic hepatitis in children, and thus may have potential applicability in clinical diagnosis of chronic hepatitis and early cirrhosis

关 键 词：儿童 肝硬化 溶胶原 透明质酸 层粘连蛋白 HA LN 放射免疫法 RIA 早期诊断 ECM 

分 类 号：R446.112[医药卫生—诊断学]