血清肝纤维化标志物对慢性乙型肝炎肝纤维化诊断价值的研究  

The diagnostic value of serum liver fibrosis markers for liver fibrosis of chronic hepatitis B

作　　者：侯丽[1] 李艳红[1] 唐婧[1] 牛瑶[1] 朱有森[1] 

机构地区：[1]新疆医科大学第一附属医院医学检验中心,新疆维吾尔自治区乌鲁木齐830054

出　　处：《实用检验医师杂志》2017年第4期234-237,共4页Chinese Journal of Clinical Pathologist

基　　金：新疆医科大学大学生科研创新基金项目(XYDCX201513)

摘　　要：目的探讨血清肝纤维化标志物透明质酸(HA)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)对慢性乙型肝炎(CHB)肝纤维化的诊断价值。方法选择119例行肝组织病理学检查的CHB患者,检测其肝纤维化血清学标志物,比较不同肝组织炎症活动度分级和纤维化程度分期患者的4项血清肝纤维化标志物水平,根据受试者工作特征曲线(ROC)探讨联合检测对CHB肝纤维化的诊断价值。结果随着肝脏炎症和纤维化程度不断加重,HA、CⅣ、PⅢP均不断升高(均P<0.05),而LN在不同分期肝脏炎症和纤维化患者中无显著差异(均P>0.05)。Spearman相关性分析显示,HA、CⅣ、PⅢP与肝脏炎症活动度和肝纤维化程度呈正相关(炎症r值为0.568、0.461、0.490,纤维化r值为0.609、0.475、0.403,均P<0.01)。多因素非条件Logistic回归分析显示,随着HA、CⅣ、PⅢP的升高,肝脏炎症、纤维化的风险也升高[炎症优势比(OR)的95%可信区间(95%CI)为1.038(1.012~1.065)、1.038(1.010~1.066)、1.025(1.004~1.047),纤维化OR(95%CI)为1.065(1.030~1.100)、1.035(1.006~1.065)、1.022(1.000~1.045)]。ROC曲线下面积(AUC)分析显示,HA+CⅣ+PⅢP联合检测的AUC大于各单项检测的AUC(0.877比0.820、0.734、0.744,均P<0.01),联合检测的敏感度为70.2%,特异度为90.3%。结论联合检测HA、CⅣ、PⅢP对诊断CHB纤维化的敏感度、特异度均较单项指标高,有助于诊断CHB患者肝纤维化,且联合检测的特异度好于灵敏度,可适当用于肝纤维化的筛查,但用于临床诊断还存在局限性。Objective To evaluate the diagnostic value of serum liver fibrosis markers Hyaluroni acid（HA）,procollagen Ⅲ（P Ⅲ P）,collagen Ⅳ（C Ⅳ）,laminin（LN） in liver fibrosis of chronic hepatitis B（CHB）.Methods Hepatic biopsies were performed on 119 CHB patients,and detected serum liver fibrosis markers,compared 4 indexes of serum liver fibrosis in different group degree of hepatic inflammation and fibrosis.To evaluate the diagnostic value of combined detection for CHB liver fibrosis by receiver operating characteristic curve（ROC）.Results With the serious degree of liver inflammation and fibrosis,the level of hyaluronic acid,pro collagen Ⅲ,collagen Ⅳ rising（all P 〈0.05）,but there was not statistically significant in the level of LN（P〉 0.05）.Spearman correlation analysis showed that HA,C Ⅳ,P Ⅲ P were positively associated with the degree of liver inflammatory activity and fibrosis（r value of inflammation was 0.568,0.568,0.461,r value of fibrosis was 0.609,0.475,0.403,respectively,all P〈 0.01）.Multivariate logistic regression analysis showed that with the HA,C Ⅳ,P Ⅲ P increased,the risk of liver inflammation and fibrosis also increased [inflammation odds ratio（OR） 95% confidence interval（95% CI） was 1.038（1.012-1.065）,1.038（1.010-1.066）,1.025（1.004-1.047）,fibrosis OR（95% CI） was 1.065（1.030-1.100）,1.035（1.006-1.065）,1.022（1.000-1.045）].Area under the ROC curve（AUC） analysis showed that HA＋ ⅣC＋PⅢP combined detection of AUC was greater than the individual the AUC（0.877 vs.0.820,0.734,0.744,all P 〈0.01）,the combined detection sensitivity was 70.2%,specificity was 90.3%.Conclusion The sensitivity and specificity of combined detection is higher than single index in CHB liver fibrosis,it is helpful to the diagnosis ofCHB with liver fibrosis,the specificity of combined detection is better than sensitivity,it can be appropriately used for screening of liver fibrosis,used for clinical diagnosis of still have limitations.

关 键 词：慢性乙型肝炎 肝脏纤维化 透明质酸 Ⅲ型前胶原肽 Ⅳ型胶原 层粘连蛋白 

分 类 号：R446.1[医药卫生—诊断学] R512.62[医药卫生—临床医学] R575.2