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血清肝纤维化指标对肝纤维化的诊断价值
Value of serum liver fibrosis markers in the diagnosis of liver fibrosis
文章发布日期:2019年09月29日  来源:  作者:张宇, 唐世孝  点击次数:246次  下载次数:58次

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【摘要】: 目的 探讨血清肝纤维化指标Ⅲ型前胶原蛋白(PCⅢ)、Ⅳ型胶原蛋白(C-Ⅳ)、透明质酸(HA)、层粘连蛋白(LN),即肝纤维化四项对肝纤维化诊断的价值。方法 回顾性分析2018年4月-2019年4月西南医科大学附属医院收治的155例肝硬化、42例肝硬化合并原发性肝癌(PHC)、150例慢性肝炎和73例健康体检者的临床资料。对所有研究对象均测定血清肝纤维化四项指标,比较各组间血清学指标的差异,并绘制受试者工作特征曲线(ROC曲线)比较肝纤维化四项的诊断效能。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验,2组间进一步比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验。结果 肝硬化患者、肝硬化合并PHC患者血清肝纤维化四项指标的水平及阳性检出率均高于慢性肝炎患者和健康体检者(P值均<0.05),但肝硬化患者与肝硬化合并PHC患者PCⅢ、C-Ⅳ和HA水平及阳性检出率比较,差异均无统计学意义(P值均>0.05)。虽然肝硬化合并PHC患者的LN水平高于肝硬化患者(P<0.05),但两者阳性检出率差异无统计学意义(P>0.05)。酒精性肝硬化患者PCⅢ、C-Ⅳ水平明显高于病毒性肝炎肝硬化、病毒性合并酒精性肝硬化及自身免疫性肝硬化患者(P值均<0.05),自身免疫性肝硬化、酒精性肝硬化、病毒性合并酒精性肝硬化患者的HA水平均高于病毒性肝炎肝硬化患者(P值均<0.05),病毒性肝炎肝硬化、病毒性合并酒精性肝硬化、酒精性肝硬化LN水平均高于自身免疫性肝硬化患者(P值均<0.05)。不同病因慢性肝炎患者肝纤维化四项指标水平及阳性检出率均低于肝硬化组(P值均<0.05),其中病毒性肝炎(重度)患者四项指标阳性检出率均高于其余各组患者(P值均<0.05)。PCⅢ、C-Ⅳ、HA、LN单独及四项指标联合检测诊断肝硬化的ROC曲线下面积分别为0.836、0.832、0.895、0.808、0.901。HA的ROC曲线下面积大于PCⅢ、C-Ⅳ、LN(P值均<0.05),但HA与四项指标联合检测的ROC曲线下面积比较差异无统计学意义(P>0.05)。结论 HA对肝纤维化具有较高的诊断效能。
【Abstract】: Objective To investigate the value of the four serum liver fibrosis markers, i.e., procollagen Ⅲ (PCⅢ), type Ⅳ collagen (C-Ⅳ), hyaluronic acid (HA), and laminin (LN), in the diagnosis of liver fibrosis. Methods A retrospective analysis was performed for the clinical data of 155 patients with liver cirrhosis, 42 patients with liver cirrhosis and primary hepatic carcinoma (PHC), and 150 patients with chronic hepatitis who were admitted to The First Affiliated Hospital of Southwest Medical University from April 2018 to April 2019, and 73 healthy individuals who underwent physical examination were also enrolled. The serum levels of the above four markers were measured for all subjects and were compared between groups. The receiver operating characteristic (ROC) curve was plotted to compare the diagnostic efficiency of these four markers. The t-test was used for normally distributed continuous data between two groups; the Kruskal-Wallis H rank sum test was used for comparison of non-normally distributed continuous data between multiple groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results The patients with liver cirrhosis and the patients with liver cirrhosis and PHC had significantly higher serum levels and positive rates of the four markers than the patients with chronic hepatitis and the healthy subjects (all P<0.05). while there were no significant differences in the levels and positive rates of PCⅢ, C-Ⅳ, and HA between the patients with liver cirrhosis and the patients with liver cirrhosis and PHC (all P>0.05). Although the patients with liver cirrhosis and PHC had a significantly higher serum level of LN than those with liver cirrhosis (P<0.05), there was no significant difference in the positive rate of LN between the two groups (P>0.05). The patients with alcoholic cirrhosis had significantly higher serum levels of PCⅢ and C-Ⅳ than those with viral cirrhosis, viral-alcoholic cirrhosis, or autoimmune cirrhosis (all P<0.05), the patients with autoimmune cirrhosis, alcoholic cirrhosis, or viral-alcoholic cirrhosis had a significantly higher serum level of HA than those with viral cirrhosis (all P<0.05), and the patients with viral-alcoholic cirrhosis, viral cirrhosis, or alcoholic cirrhosis had a significantly higher serum level of LN than those autoimmune(all P<0.05). The patients with chronic hepatitis of different etiologies had significantly lower serum levels and positive rates of these four markers than those with liver cirrhosis (all P<0.05), and the patients with severe viral hepatitis had significantly higher positive rates of the four markers than the other patients (all P<0.05). PCⅢ, C-IV, HA, LN, and the combination of these four markers had an area under the ROC curve of 0.836, 0.832, 0.895, 0.808, and 0.901, respectively, in the diagnosis of liver cirrhosis. HA had a significantly larger area under the ROC curve than PCⅢ, C-Ⅳ, and LN (all P<0.05), while there was no significant difference between HA and the combination of these four markers (P>0.05). Conclusion HA has a high diagnostic efficiency in liver fibrosis.
【关键字】:肝硬化; 诊断; 对比研究
【Key words】:liver cirrhosis; diagnosis; comparative study
【引证本文】:ZHANG Y, TANG SX. Value of serum liver fibrosis markers in the diagnosis of liver fibrosis[J]. J Clin Hepatol, 2019, 35(11): 2466-2471. (in Chinese)
张宇, 唐世孝. 血清肝纤维化指标对肝纤维化的诊断价值[J]. 临床肝胆病杂志, 2019, 35(11): 2466-2471.

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