血清肝纤维化标志物与慢性丁型肝炎肝纤维化程度关系的探讨  

Relationship between serum markers and severity of liver fibrosis in patients with chronic hepatitis D

作　　者：周颖[1] 熊红品 陈铿[1] 平岖[1] 廖宝林[1] 

机构地区：[1]广州市第八人民医院肝病科,广州510060

出　　处：《临床肝胆病杂志》2015年第3期361-364,共4页Journal of Clinical Hepatology

摘　　要：目的探讨ALT、HBV DNA及血清纤维化标志物透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)与慢性丁型肝炎(CHD)患者肝纤维化程度的关系。方法收集2008年3月至2013年1月在广州市第八人民医院肝病科住院并未曾接受任何抗病毒治疗的CHD患者28例,检测患者血清中ALT、HBV DNA和纤维化标志物(HA、LN、PⅢP及CⅣ)的水平,并行肝活组织检查检测肝组织纤维化分期。HBe Ag阳性与阴性组间计量资料比较采用t检验,计数资料比较采用χ2检验,不同纤维化分期间比较采用非参数检验中的Kruskal-Wallis检验;相关性分析采用Spearman等级相关分析。结果 HBe Ag阳性与HBe Ag阴性组患者间肝纤维化程度差异无统计学意义(χ2=0.129,P=0.720)。肝纤维化S1、S2及S≥3 3组间HA及LN水平差异有统计学意义(Z值分别为12.035、8.457,P值分别为0.002、0.015),其中S≥3组患者水平最高[HA:(169.4±166.3)ng/ml,LN:(149.2±85.1)ng/ml]且与S1、S2组比较差异均存在统计学意义(P值均<0.05),而3组间其他实验室指标ALT、HBV DNA、PⅢP及CⅣ水平差异均无统计学意义(P值均>0.05)。肝纤维化分期与HA、LN、PⅢP及CⅣ水平呈正相关(r值分别为0.512、0.472、0.451、0.454,P值分别为0.005、0.011、0.016、0.015)。结论 HA、LN水平可能作为评估CHD患者肝纤维化程度的血清学指标。Objective To explore the relationship between levels of alanine aminotransferase（ ALT）,hepatitis B virus（ HBV） DNA,and serum markers of fibrosis including hyaluronic acid（ HA）,laminin（ LN）,type Ⅲ procollagen peptide（ PⅢP）,and type Ⅳ collagen（ CⅣ） and the severity of liver fibrosis in patients with chronic hepatitis D（ CHD）. Methods Twenty- eight patients with CHD who were inpatients in our hospital from March 2008 to January 2013 and had not received any antiviral treatment were enrolled as subjects. Serum levels of ALT,HBV DNA,and fibrosis markers（ HA,LN,PIIIP,and CIV） in patients were determined,and the histopathological staging of liver fibrosis was measured by liver biopsy. Continuous data were expressed as mean ± standard deviation and compared of continuous data between the HBe Ag- positive group and the HBe Ag- negative group by t test,and comparison of categorical data was made by χ2test. Comparison between different fibrosis stages was made by the Kruskal- Wallis nonparametric test. Correlation analysis was made by the Spearman rank method. Results There were no significant differences in progression of liver fibrosis between the HBe Ag- positive group and the HBe Ag- negative group（ χ2= 0. 129,P = 0. 720）. There were significant differences in levels of HA and LN between groups with liver fibrosis stages 1,2,and ≥3（ Z = 12. 035,P = 0. 002; Z = 8. 457,P = 0. 015）. Levels of HA（ 169. 4 ± 166. 3 ng / ml） and LN（ 149. 2 ±85. 1 ng / ml） in the stage ≥3 group were significantly higher than those in the stage 1 group and the stage 2 group（ P 〈 0. 05）. There were no significant differences in levels of ALT,HBV DNA,PIIIP,and CIV between three groups. The severity of liver fibrosis was positively correlated with levels of HA,LN,PIIIP,and CIV（ r = 0. 512,P = 0. 005; r = 0. 472,P = 0. 011; r = 0. 451,P = 0. 016; r = 0. 454,P =0. 015）. Conclusion Levels of HA and LN can be used as serum markers to determine the severity of liver fibrosis in p

关 键 词：肝炎 丁型 慢性 肝硬化 透明质酸 层黏连蛋白 胶原Ⅵ型 

分 类 号：R512.64[医药卫生—内科学] R575.2[医药卫生—临床医学]