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目的探讨血清肝纤维化标志物和1H磁共振波谱分析(1H-MRS)指标在兔肝纤维化中的诊断效能及相互关系。方法健康新西兰大白兔45只,随机分为6组:第1组为对照组,5只;第2~6组为实验组,每组8只,共40只。对以四氯化碳(CCl4)诱导产生的肝纤维化实验组兔和对照组兔行血清肝纤维化标志物和1H-MRS检查。血清学指标包括透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)和层黏连蛋白(LN),1H-MRS参数为胆碱峰高choAmp、胆碱面积choAre、胆碱/脂质峰高比值(cho/lipid)Amp和胆碱/脂质面积比值(cho/lipid)Are。以病理学肝纤维化分期S≥1为判断阳性的标准,应用受试者工作特性曲线(ROC)评价两者各诊断指标在肝纤维化中的诊断效能,同时行血清学和1H-MRS指标间的相关性分析。结果 ROC曲线下面积血清HA(0.893)>C-Ⅳ(0.804)>LN(0.732)>PCⅢ(0.643),1H-MRS中依次为(cho/lipid)Amp(0.753)>(cho/lipid)Are(0.742)>choAre(0.544)>choAmp(0.497);除choAmp外,所有指标的曲线下面积、灵敏度和特异度均在0.5~0.9之间。choAmp、choAre与C-IV之间存在显著正相关(P<0.01),choAre、(cho/lipid)Are与LN存在正相关(P<0.05),(cho/lipid)Amp与血清学各指标间无相关性。结论血清肝纤维化标志物和1H-MRS在诊断肝纤维化中能力相仿,但无灵敏度和特异度俱佳的诊断指标。两者之间存在的相关关系可能与间质纤维化影响代谢物的交换和排出有关。
Objective To investigate the diagnostic efficacy and correlation of serum liver fibrosis markers and 1H magnetic resonance spectroscopy (1H-MRS) markers in rabbit liver fibrosis. Methods Forty five New Zealand white rabbits were randomly divided into 6 groups: group 1 as control group and group 5 as experimental group; group 2 to group 6 as experimental group with 8 rats for each group. Serum liver fibrosis markers and 1H-MRS were used to detect liver fibrosis induced by carbon tetrachloride (CCl4) in experimental group and control group. Serum indicators include hyaluronic acid (HA), type III procollagen (PCIII), type IV collagen (C-IV) and laminin (LN), 1H-MRS parameters for choline peak choAmp, choline area choAre, cho / lipid Amp and cho / lipid Are. Pathological liver fibrosis staging S≥1 was used as a criterion to evaluate the diagnostic performance of each diagnostic index in liver fibrosis by using the receiver operating characteristic curve (ROC). Serological and 1H-MRS indexes Correlation analysis. Results The areas under the ROC curve were (cho / lipid) Amp (0.753)> (cho / lipid) Are (HA> 0.893> C-IV 0.84> LN 0.732> PCIII 0.643) (0.742)> choAre (0.544)> choAmp (0.497). The area under the curve, sensitivity and specificity of all indicators except choAmp were between 0.5 and 0.9. There was a significant positive correlation between choAmp, choAre and C-IV (P <0.01), choAre, (cho / lipid) Are and LN were positively correlated (P <0.05) No correlation. Conclusions Serum markers of liver fibrosis and 1H-MRS have similar abilities to diagnose liver fibrosis but no diagnostic criteria for sensitivity and specificity. The correlation between the two may be related to interstitial fibrosis affecting the exchange and excretion of metabolites.