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目的基于药物干预前后的肝组织病理动态变化情况,探讨肝功能、肝纤维化血清学指标在慢性乙型肝炎肝纤维化诊断和预后判断中的价值。方法根据扶正化瘀胶囊抗慢性乙型肝炎肝纤维化多中心、随机、双盲、对照临床试验中93例(包括试验组和对照组)治疗6个月前后2次肝活体组织病理学检查的资料, 并依据肝组织纤维化程度减轻和未减轻(或继续加重)的情况将病例分为两组(减轻组36例,未减轻组57例), 分析该两组肝组织炎症、肝功能、肝纤维化血清学指标及相应的血常规变化规律。结果纤维化减轻组伴有肝组织炎症程度的显著减轻。药物干预后,纤维化减轻组的血清透明质酸和Ⅲ型前胶原肽含量明显下降 (t＝3．34与t＝3．17,P值均＜0．01),并显著低于未减轻组；但层黏连蛋白和IV型胶原含量差异均无统计学意义。纤维化减轻组伴有血清白蛋白升高(t＝3．2 4,P＜0．01)及γ—谷氨酰转肽酶、天冬氨酸氨基转移酶活性和凝血酶原时间的下降,而未减轻组无类似变化。结论慢性乙型肝炎肝纤维化患者血清γ-谷氨酰转肽酶、天冬氨酸氨基转移酶活性,凝血酶原时间,白蛋白、血清透明质酸和Ⅲ型前胶原肽含量的变化有助于肝纤维化减轻与否的判断和药物疗效评价,而血清层黏连蛋白和IV型胶原含量在肝纤维化诊断中的价值有待商榷。
Objective To evaluate the value of liver function and serum fibrosis markers in diagnosis and prognosis of chronic hepatitis B liver fibrosis based on the changes of liver histopathology before and after drug intervention. Methods According to the histopathological examination of liver biopsy in 93 patients (including experimental group and control group) treated with Fuzhenghuayu Capsule for 6 months before the treatment of chronic hepatitis B liver fibrosis in multicenter, randomized, double-blind and controlled clinical trial Data were collected and divided into two groups according to the extent of liver fibrosis (or continued to increase): 36 cases in relief group and 57 cases in non-relief group. The liver inflammation, liver function, Hepatic fibrosis serological indicators and corresponding changes in blood routine. Results There was a significant reduction in the severity of liver inflammation associated with fibrotic relief. After drug intervention, the levels of serum hyaluronic acid and type Ⅲ procollagen peptide in fibrosis alleviation group were significantly decreased (t = 3.34 and t = 3.17, P <0.01), and were significantly lower than those without mitigation Group; however, there was no significant difference in laminin and IV collagen content. Fibrosis was associated with a decrease in serum albumin (t = 3.2 4, P <0.01) and γ-glutamyl transpeptidase, aspartate aminotransferase activity and prothrombin time , While no mitigation group had no similar changes. Conclusion The changes of serum glutamyltranspeptidase, aspartate aminotransferase, prothrombin time, albumin, serum hyaluronic acid and procollagen Ⅲ in chronic hepatitis B patients with liver fibrosis Contribute to the judgment of liver fibrosis alleviation or not and the evaluation of drug efficacy, but the value of serum laminin and type IV collagen in the diagnosis of liver fibrosis remains to be discussed.