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目的 探讨慢性肝炎患者血清纤维化指标 [血清透明质酸 (HA)、Ⅲ型前胶原 (PCⅢ )、Ⅳ型胶原 (Ⅳ C)、层黏蛋白 (LN) ]的临床实用价值。方法 对 2 6 0 0例慢性肝炎轻、中、重度患者 ,用放免法检测血清HA、PCⅢ、Ⅳ C、LN ,并对其中的 2 80例进行肝穿刺标本病理组织学检查 ,作肝脏炎症活动度分级、肝纤维化程度分期及慢性肝炎病理组织学分度 ,探讨它们与纤维化指标之间关系。结果 2 6 0 0例轻、中、重度慢性肝炎患者 ,4项指标之间均有明显差异 (P <0 0 1)。这 4项指标均与肝脏炎症活动度分级、肝纤维化程度分期及慢性肝炎的分度有关。相关系数HA分别为 0 5 44、0 5 48和 0 46 8;PCⅢ为 0 495、0 42和 0 335 ;Ⅳ C为 0 40 6、0 40 4和 0 412 ;LN为 0 2 14、0 2 0 4和 0 184。结论 血清学检测对慢性肝炎的诊断有较大的临床指导作用 ,但对某一患者评价这些指标的意义时 ,应结合肝功能检查、B超检查及临床表现 ,作全面分析。
Objective To investigate the clinical value of serum fibrosis indicators (serum HA, PC Ⅲ, Ⅳ C and laminin) in patients with chronic hepatitis. Methods Serum HA, PCⅢ, Ⅳ C and LN were detected by radioimmunoassay in 2600 patients with mild, moderate and severe chronic hepatitis, and pathological examination of liver biopsy specimens was performed in 280 cases of them. Liver inflammation Degree grading, degree of liver fibrosis staging and histological grade of chronic hepatitis, to explore their relationship with fibrosis indicators. Results There were significant differences among the 4 indicators in 2600 patients with mild, moderate and severe chronic hepatitis (P <0.01). These four indicators are related to the grading of liver inflammation activity, the degree of liver fibrosis and the degree of chronic hepatitis. The correlation coefficients HA were 0 5 44,0 5 48 and 0 468 respectively; PC III was 0 495, 0 42 and 0 335; IV C was 0 40 6,0 40 4 and 0 412; LN was 0 2 14,0 2 0 4 and 0 184. Conclusions Serological tests have great clinical significance in the diagnosis of chronic hepatitis. However, in evaluating the significance of these indexes in a certain patient, we should make a comprehensive analysis with liver function tests, B-ultrasound and clinical manifestations.