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目的 初步评价 4项细胞外间质 (ECM )指标包括透明质酸 (HA)、Ⅳ型胶原 (ColⅣ )、Ⅲ型胶原N端肽 (PⅢNP)和层粘蛋白 (LN)在肝纤维化非创伤性诊断中的价值。方法 以上海市各大医院选送的符合入选标准的慢性肝病患者血清为研究对象 ,采用RIA检测HA、PⅢNP、LN ,ELISA检测ColⅣ ,比较这 4项指标与病理检查结果即组织学炎症、纤维化分级、分期的相关性。结果 HA、ColⅣ在炎症不同级及纤维化不同期的检测水平随炎症及纤维化的进展逐渐升高并有显著差异 ,提示HA、ColⅣ与炎症及纤维化程度有较好相关性。PⅢNP水平在一定程度上反映炎症轻度、重度的变化 ,但在纤维化不同期无显著差异。LN在不同炎症及纤维化级期中均无显著差异 ,因而不能反映炎症及纤维化程度。这 4项指标诊断肝纤维化的准确性、特异性和敏感性自高至低依次为HA、ColⅣ、PⅢNP和LN。结论 本研究中的 4项指标在肝纤维化及炎症中的诊断价值以HA最高 ,其次为ColⅣ ,其中HA不仅能反映慢性肝病的纤维化和炎症性改变 ,对监测炎症和纤维化进展亦有较高价值。既往认为具有较高诊断价值的PⅢNP和LN在本研究中未能得到证实 ,提示他们的诊断意义尚需进一步探讨。
OBJECTIVE: To evaluate the clinical significance of four extracellular matrix (ECM) markers, including hyaluronic acid (HA), type Ⅳ collagen (Col Ⅳ), type Ⅲ collagen N-terminal peptide (PⅢNP) and laminin (LN) The value of sexual diagnosis. Methods The sera from patients with chronic liver disease who were selected by the major hospitals in Shanghai were selected as research objects. HA, PⅢNP and LN were detected by RIA, and Col Ⅳ was detected by ELISA. The four indexes were compared with histopathological findings of inflammation, fibrosis Classification, staging of relevance. Results The levels of HA and ColⅣ in different stages of inflammation and in different stages of fibrosis gradually increased with the progress of inflammation and fibrosis, which showed that there was a good correlation between HA and Col Ⅳ and the degree of inflammation and fibrosis. PⅢNP level to a certain extent, reflect mild and severe changes in inflammation, but no significant difference in different stages of fibrosis. LN in different stages of inflammation and fibrosis no significant difference, and therefore can not reflect the degree of inflammation and fibrosis. These four indicators of liver fibrosis diagnosis accuracy, specificity and sensitivity from high to low HA, Col Ⅳ, P Ⅲ NP and LN. Conclusions The four indicators in this study are the most valuable for the diagnosis of hepatic fibrosis and inflammation, followed by ColⅣ, in which HA not only reflects the changes of fibrosis and inflammation in chronic liver disease but also monitors the progress of inflammation and fibrosis Higher value. Previously, PⅢNP and LN with high diagnostic value were not confirmed in this study, suggesting that their diagnostic significance needs further exploration.