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目的 :探讨乙肝患者血清Ⅳ型胶原 (Ⅳ -C)、Ⅲ型前胶原 (PCⅢ )、脯氨酸肽酶 (PLD)、透明质酸 (HA)和层粘连蛋白 (LN)对肝纤维化的诊断价值。方法 :采用RIA对 1 0 3例乙肝患者血清中的这几个指标的代谢变化进行了观察 ,并对其中 35例肝活检患者中这些指标与肝纤维化程度之间的相关性进行了分析。结果 :与正常人相比 ,慢活肝 (CAH)和肝硬化 (LC)患者血清Ⅳ -C、PCⅢ、LN、HA和PLD水平明显增高 (P <0 .0 1 ) ,而慢迁肝 (CPH)和急性肝炎 (AH)患者上述各项指标的变化与正常人比较差异并不明显 (P >0 .0 5 )。血清Ⅳ -C、PCⅢ、LN、HA和PLD的异常高值趋向性地向LC和CAH集中 ,其升高的方向及程度与肝损害和肝纤维化发展的方向及程度保持良好的一致性。相关分析亦发现肝活检患者肝纤维化程度与其血清Ⅳ -C、PCⅢ、LN、HA和PLD水平的变化呈显著正相关 (n =35 ,r=+0 .6 4 - +0 .89,P <0 .0 1 )。结论 :血清Ⅳ -C、PCⅢ、LN和PLD等指标均能较好地反映乙肝的慢性化程度和肝纤维化的活动水平及程度 ,且较少受肝细胞损伤性因素的影响。在反映肝纤维化程度方面 ,HA和LN似更优于Ⅳ -C、PCⅢ和PLD。
OBJECTIVE: To investigate the effect of serum levels of type Ⅳ collagen, type Ⅲ procollagen, prolyl peptidase (PLD), hyaluronic acid (HA) and laminin (LN) on hepatic fibrosis Diagnostic value. Methods: The RIA was used to analyze the changes of these indexes in serum of 103 patients with hepatitis B, and the correlation between them and the degree of liver fibrosis in 35 patients with liver biopsy was analyzed. Results: The serum levels of Ⅳ -C, PCⅢ, LN, HA and PLD in CAH and LC patients were significantly higher than those in normal controls (P <0.01) CPH) and acute hepatitis (AH) patients with changes in these indicators compared with normal people was not significant (P> 0.05). The abnormally high values of serum IV-C, PCIII, LN, HA and PLD tended to converge to LC and CAH, and the direction and degree of their elevation were in good agreement with the direction and degree of development of liver damage and hepatic fibrosis. Correlation analysis also found that liver biopsy patients with liver fibrosis and its serum levels of Ⅳ -C, PC Ⅲ, LN, HA and PLD levels were significantly positively correlated (n = 35, r = +0.44 +0.89, P <0 .0 1). Conclusion: The indexes of serum Ⅳ -C, PC Ⅲ, LN and PLD can reflect the degree of chronic hepatitis B and liver fibrosis activity, and less affected by the injury of liver cells. In reflecting the degree of liver fibrosis, HA and LN seem to be superior to IV-C, PCIII and PLD.