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目的评价血清纤维化指标透明质酸(HA)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原肽(PⅢP)、层黏连蛋白(LN)对肝纤维化诊断的价值。方法对确诊的慢性乙型肝炎患者50例和健康人18例,测定血清纤维化指标水平,并进行肝组织纤维化分期。根据受试者工作特征曲线判别4项指标对于肝纤维化分期的诊断价值。结果血清HA、CⅣ、PⅢP和肝脏组织炎症分级呈较弱正相关(r分别为0.430、0.382和0.300,P<0.05)。血清HA、CⅣ与肝脏组织纤维化分期呈中度正相关(r分别为0.614、0.708,P<0.05)。血清HA、CⅣ水平随肝纤维化的进展程度而升高。血清HA诊断早期肝硬化(S4)的受试者工作特征曲线下面积(AUC)大于血清CⅣ、PⅢP和LN(AUC=0.967比0.932、0.659、0.403)。血清CⅣ诊断肝纤维化(S1~S4)的AUC大于血清HA、PⅢP和LN(AUC=0.853比0.680、0.536、0.487)。血清LN对于肝组织分级或分期均无统计学意义。联合HA+CⅣ检测比单一指标有更高的特异度。结论血清纤维化指标对肝纤维化进程有一定的预测意义,但不能对肝纤维化精确分期,因此不能取代肝组织病理活检。联合多项指标检测可在一定程度上提高检测效率。寻找新的血清标志物和联合其他标志物是肝纤维化无创性研究的趋势所在。
Objective To evaluate the diagnostic value of serum fibrosis indicators of hyaluronic acid (HA), type Ⅳ collagen (C Ⅳ), type Ⅲ procollagen peptide (P Ⅲ P) and laminin (LN) in the diagnosis of hepatic fibrosis. Methods 50 cases of chronic hepatitis B patients and 18 healthy people were diagnosed. Serum levels of serum fibrosis were measured and staging of liver fibrosis was performed. According to the working curve of the subjects, the diagnostic value of four indexes for the staging of liver fibrosis was discriminated. Results Serum HA, CⅣ, PⅢP had a weak positive correlation with liver inflammation (r = 0.430, 0.382 and 0.300, respectively, P <0.05). Serum HA and CⅣ had a moderate positive correlation with liver fibrosis staging (r = 0.614,0.708, P <0.05). Serum HA, C Ⅳ levels with the degree of progress of liver fibrosis and increased. The area under the working characteristic curve (AUC) for serum HA in diagnosing early cirrhosis (S4) was greater than serum CIV, PIIIP and LN (AUC = 0.967 vs. 0.932, 0.609, 0.403). The AUC of serum C IV in diagnosing liver fibrosis (S1 ~ S4) was higher than that of serum HA, PⅢP and LN (AUC = 0.853 vs 0.680, 0.536, 0.487). Serum LN for liver grading or staging were not statistically significant. The combined HA + CIV test has a higher specificity than a single indicator. Conclusion Serum fibrosis indicators have certain predictive value on the progress of liver fibrosis, but can not accurately staging liver fibrosis and therefore can not replace biopsy of liver tissue. Combined with a number of indicators can improve the detection efficiency to some extent. Finding new serum markers combined with other markers is a noninvasive trend toward liver fibrosis.