病毒性肝炎患者肝纤维化血清标志物的临床价值

目的探讨病毒性肝炎四项血清标志物透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ)、IV型胶原(IVC)水平的变化。方法应用放射免疫分析法测定了330例病毒性肝炎患者血清中HA、LN、PCⅢ、IVC的含量,并与对照组进行比较。结果(1)HA急性病毒性肝炎与对照组无差别,慢性病毒性肝炎各组随慢性化进展呈梯度升高,组间差异有统计学意义。(2)LN慢性中度与慢性重度间有差别,其它各组间无差别。(3)PCⅢ急性病毒性肝炎、慢性各组均高于正常对照组,急性病毒性肝炎与慢性轻型间无差别。(4)IVC急性病毒性肝炎与正常对照组无差别,其它组间均有差别。结论测定病毒性肝炎患者血清HA、LN、PCⅢ、IVC等四项血清标志物水平或动态观察其变化,对辅助临床诊断、鉴别诊断、治疗、判定预后具有重要临床价值。     

病毒性肝炎患者肝纤维化血清标志物的临床价值

目的 探讨病毒性肝炎四项血清标志物透明质酸(HA)、层粘蛋白(LN)、Ⅲ型前胶原(PCⅢ,、Ⅳ型胶原(IVC)水平的变化.方法 应用放射免疫分析法测定了330例病毒性肝炎患者血清中HA、LN、PCⅢ、IVC的含量,并与对照组进行比较.结果 (1)HA急性病毒性肝炎与对照组无差别,慢性病毒性肝炎各组随慢性化进展呈梯度升高,组间差异有统计学意义.(2)LN慢性中度与慢性重度间有差别,其它各组间无差别.(3)PCⅢ急性病毒性肝炎、慢性各组均高于正常对照组,急性病毒性肝炎与慢性轻型间无差别.(4)IVC急性病毒性肝炎与正常对照组无差别,其它组间均有差别.结论 测定病毒性肝炎患者血清HA、LN、PCⅢ、IVC等四项血清标志物水平或动态观察其变化,对辅助临床诊断、鉴别诊断、治疗、判定预后具有重要临床价值.     

肝病患者肝纤维化血清标志物的测定与意义

肝病患者肝纤维化血清标志物的测定与意义高丽菊李兰芬孙革新施丽（解放军第一医院检验科，兰州７３００３０）关键词肝纤维化透明质酸层粘连蛋白Ⅲ型胶原前体Ⅳ型胶原各型病毒性肝炎在慢性转化时，都会发生纤维组织的增生（肝纤维化）。采用非创伤性的检查方法，及时对肝...     

肝纤维化血清标志物的进展

肝纤维化是肝硬化的早期阶段，它是一种病理学诊断，目前临床上对肝纤维化或肝硬化的确诊仍以肝穿活体组织检查为主，如何寻找一种非损伤性诊断途径，是国内外肝脏医学研究的热点，近年来发展迅速，尤其是在血清标志物方面，具有重要的诊断价值．本文就近年的内容概要介绍如下：1反映胶原蛋白代谢改变的指标反映的类型较多，迄今已发现14型[1]，在肝组织中有Ⅰ、Ⅲ、Ⅳ、Ⅴ和Ⅵ型，其中含量最多的是Ⅰ和Ⅲ型[2]，见表1．资料表明[2]，Ⅲ型前胶原氨基端前肽（PⅢP）与肝脏纤维化形成的活动程度有密切的相关性。并且在肝纤维化胶原合成时，早…     

肝爽颗粒治疗慢性乙型病毒性肝炎肝纤维化疗效观察

目的:观察肝爽颗粒对乙型病毒性肝炎肝纤维化的治疗作用。方法:应用肝爽颗粒治疗慢性乙型病毒性肝炎肝纤维化患者78例,并与安络化纤丸(对照组)进行比较,观察治疗前后症状、体征、肝功能、肝纤维化等指标。结果:肝爽颗粒可改善肝区疼痛、食欲不振、体倦乏力等症状;可降低血清HA、LN、IV-C肝纤维化指标,并可改善肝功能。结论:肝爽颗粒对乙型病毒性肝炎肝纤维化有改善作用。     

260例病毒性肝炎血清标志物的调查

２６０例病毒性肝炎血清标志物的调查内蒙古呼和浩特铁路中心医院检验科（０１００１０）李佳英李荣显戚彦娟王红梅甲型病毒性肝炎主要经粪－口途径传播，多为自限性急性感染。乙、丙型肝炎以血源途径传播为主，且多有潜在性或非显性及进展为慢性感染，乃至发展为肝硬化和...     

肝静脉多普勒超声及血清标志物测定诊断肝纤维化的对比研究

目的：比较肝静脉多普勒超声和血清标志物检测诊断肝纤维化的价值。方法：用上述二种方法同时对７０例慢性肝病患者和４０例正常人进行检测。结果：慢性肝病患者肝静脉多普勒波形改变具有相对恒定的特征变化;血清透明质酸（ＨＡ）,Ⅲ型前胶原（ＰＣⅢ）和层粘蛋白（ＬＮ）水平比正常对照组显著增高。结论;肝静脉多普勒法诊断肝纤维化明显优于血清法,是诊断肝纤维化较可靠的无创伤性方法。     

抗纤丸治疗病毒性肝炎肝纤维化临床观察

目的观察抗纤丸对病毒性肝炎肝纤维化患者的疗效。方法将120例患者按随机非盲法分为两组,观察组给予口服抗纤丸,9g/粒,每天早晚各服1粒;对照组给予口服鳖甲煎丸,3g/次,2次/d口服。3个月为1个疗程,两组均观察1个疗程。两组病例同时均给予益肝灵、维生素C、复合维生素B等必要的保肝、支持、对症治疗。治疗前、后检测血清透明质酸(HA)、层黏蛋白(LN)、Ⅳ型胶原(IVC)、肝功能及检查肝脾B超。结果观察组疗效优于对照组(P<0.05),两组治疗前、后HA、LN、IVC明显下降(P<0.05),而观察组下降更显著(P<0.01),观察组与对照组比较差异有统计学意义(P<0.05)。结论抗纤丸治疗病毒性肝炎肝纤维化有良好的疗效。     

乙肝肝硬化患者病毒血清标志物及外周血小板计数与肝纤维化程度的相关性

目的探讨乙肝肝硬化患者病毒血清标志物及外周血小板计数与肝纤维化程度的相关性。方法选取80例乙型肝炎肝硬化代偿期患者设为观察组,并选取同期收治的190例慢性乙型肝炎患者设为对照组,对比2组患者的肝纤维化程度、乙肝核心抗体(HBcAb)滴度、乙肝核心抗体Ig M (HBcAb-IgM)滴度、乙肝表面抗原(HBsAg)滴度Log值及外周血小板计数,并探讨肝纤维化程度与这些指标的相关性。结果观察组患者肝纤维化程度分级及HBcAb滴度均显著高于对照组(P 0. 05),而外周血小板计数(162. 6±43. 4)×109/L、HBcAb-IgM滴度(0. 08±0. 05) S/CO、HBsAg滴度Log值(3. 3±0. 2) IU/m L均显著低于对照组(P 0. 05)。相关性分析显示,观察组肝纤维化程度与HBcAb滴度、HBsAg滴度Log值及外周血小板计数存在线性相关(P值分别为0. 004、0. 001、0. 012,相关系数分别为0. 540、-0. 717、-0. 478)。结论相对于慢性乙型肝炎患者,乙型肝炎肝硬化代偿期患者肝纤维化程度及HBcAb滴度较高,而外周血小板计数、HBcAb-IgM滴度及HBsAg滴度Log值较低,且肝纤维化程度与HBcAb滴度、HBsAg滴度Log值及外周血小板计数存在线性相关。     

肝静脉管径及多普勒频谱与慢性病毒性肝炎肝纤维化的相关 …

探讨慢性病毒性肝炎肝静脉管径及多普勒频谱改变与肝组织病理纤维化程度的关系。方法应用彩色多普勒超声观测了１１３例慢性病毒性肝炎患者肝中静脉直径,及多普勒频谱改变,并与肝组织病理纤维化分期进行相关性分析。结论肝静脉管径及多普勒频谱的变化在判别慢性病毒性肝炎肝纤维化的程度方面有重要诊断价值。     

Validation of the FibroTest biochemical markers score in assessing liver fibrosis in hepatitis C patients

BACKGROUND: Determining the stage of fibrosis by liver biopsy is important in managing patients with hepatitis C virus infection. We investigated the predictive value of the proprietary FibroTest score to accurately identify significant fibrosis in Australian hepatitis C patients. METHODS: Serum obtained from 125 confirmed hepatitis C patients before antiviral therapy was analyzed for haptoglobin, alpha(2)-macroglobulin, apolipoprotein A1, bilirubin, and gamma-glutamyltransferase activity, and the FibroTest score was computed. Liver fibrosis pathology was staged according to a defined system on a scale of F0 to F4. We used predictive values and a ROC curve to assess the accuracy of FibroTest scores. RESULTS: The prevalence of significant fibrosis defined by liver biopsy was 0.38. The most useful single test for predicting significant fibrosis was serum alpha(2)-macroglobulin (cutoff value, 2.52 g/L; sensitivity, 75%; specificity, 67%). The negative predictive value of a FibroTest score <0.1 was 85%, and the positive predictive value of a score >0.6 was 78%. Although 33 of the 125 patients had FibroTest scores <0.1 and were therefore deemed unlikely to have fibrosis, 6 (18%) had significant fibrosis. Conversely, of the 24 patients with scores >0.6 who were likely to have significant fibrosis, 5 (21%) had mild fibrosis. Of the 125 patients in the cohort, 57 (46%) could have avoided liver biopsy, but discrepant results were recorded in 11 of those 57 (19%). CONCLUSION: The FibroTest score could not accurately predict the presence or absence of significant liver fibrosis.     

Usefulness of six non-proprietary indirect markers of liver fibrosis in patients with chronic hepatitis C.

BACKGROUND: The aim of the study was to perform a comprehensive diagnostic evaluation of six popular, non-proprietary, indirect markers of liver fibrosis in a cohort of patients with chronic hepatitis C representing the full spectrum of disease severity. METHODS: A total of 167 consecutive, hepatitis C virus RNA positive, untreated patients with chronic hepatitis C were studied. Liver biopsy with histological evaluation and age/platelet index, aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, Bonacini's discriminant score, Forn's fibrosis index and FibroIndex were assessed in all patients. RESULTS: The area under the receiver operating characteristic curves of the six tests was always greater when performed to discriminate patients with METAVIR score F4 than when assessed to discriminate patients with METAVIR score > or =F2. At step-wise discriminant analysis the only indirect marker of fibrosis entered was FibroIndex, with the following correct classification of the patients: total=52.1, patients with scores F0-F1=62.2, patients with scores F2-F3=26.0 and patients with score F4=68.4. CONCLUSIONS: The ability to correctly classify patients using a panel of non-proprietary indirect markers of liver fibrosis is far from being ideal. Among them, FibroIndex appears to possess the best discriminating capacity. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy.     

The diagnostic value of the detection of hepatic fibrosis serum markers in chronic viral hepatitis

The diagnostic significance of serum markers of fibrosis was investigated in 92 patients with chronic viral hepatitis (CVH) by studying the collagenolythic activity of blood, proteasic inhibitor activity, collagen metabolism products (oxyproline fraction), and fibronectin. At the same time, the patients underwent puncture biopsy of the liver, which made it possible to determine the degree of process activity and the stage of its chronization. As the degree of fibrosis grew, the collagenase serum activity increased significantly, while the alpha1-proteinase inhibitor activity fell, the content of oxyproline (its fractions) increased, and the fibronectin level decreased. Hence, the measurement of the noted parameters allows for noninvasive diagnostics of CVH stages.     

化学发光法检测慢性乙型肝炎肝纤维化四项标志结果分析

目的探讨应用化学发光法定量检测肝纤维化指标透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原氮端肽(PⅢNP)、Ⅳ型胶原(CⅣ)对肝纤维化的诊断价值。方法应用化学发光法检测了196例乙型肝炎病毒感染者血清样本的肝纤维化指标。其中乙型肝炎病毒携带者50例,慢性乙型肝炎患者48例,慢性重肝36例,乙型肝炎肝硬化患者62例,正常对照40例,并对结果进行统计学分析。结果肝纤维化四项指标(HA、LN、PⅢNP、CⅣ)在乙型肝炎携带者、慢性乙型肝炎、慢性重肝、乙型肝炎肝硬化测定值之间差异有统计学意义(P<0.05)。测定值升高的幅度为:慢性重肝>乙型肝炎肝硬化>慢性乙型肝炎>乙型肝炎携带者。结论应用化学发光法动态检测肝纤维化四项指标是指导临床判断肝纤维化程度的非损伤性的良好检测方法。     

兰州地区慢性乙型肝炎患者病毒复制与肝纤维化指标的相关性研究

目的：探讨兰州地区慢性乙型肝炎（CHB）患者肝纤维化四项指标：层粘连蛋白（LN）、透明质酸（HA）、Ⅳ型胶原（CⅣ）、Ⅲ型前胶原 N 端肽（PⅢNP）与乙型肝炎病毒（HBV）DNA 复制的相关性。方法分别采用化学发光法和实时荧光定量 PCR （RT-PCR）法检测肝纤维化指标和 HBV-DNA,以不同临床分型和自然史分期为背景,对兰州地区724例 HBV 感染者的肝纤维化指标和病毒复制作量化检测研究。结果在所有临床类型中,肝纤维化指标和 HBV-DNA 数值均高于正常,且最高为乙型肝炎肝硬化组;CⅣ、PⅢNP 均以 HBeAg（＋）CHB 组最高。按乙型肝炎自然史分期,P ⅢNP、CⅣ在免疫清除期最高且 CⅣ在HBeAg 及 HBV-DNA（＋）组中均值都高于 HBeAg 及 HBV-DNA（-）组。四项指标均为 HBeAg（＋）CHB 组高于 HBeAg（-） CHB 组,但仅有 HA 有统计学差异（P ＜0．01）。结论 CⅣ与 HBV-DNA 以及 HBV-M 具有一定相关性,提示其可以间接反映肝损害程度以及病毒复制水平。     

自身免疫性肝病患者肝纤维化血清标志物检测的意义

目的 探讨血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)和层粘连蛋白(LN)对自身免疫性肝病(ALD)患者肝纤维化诊断及鉴别的意义.方法 采用增强化学发光免疫分析法对37例原发性胆汁性肝硬化(PBC)患者、25例自身免疫性肝炎(AIH)患者、33例肝硬化患者、37例病毒性肝炎患者及20例健康体检者血清HA、PCⅢ、CⅣ、LN进行检测,并对部分患者在治疗6个月后再次检测上述指标,同时和部分肝功能指标进行相关性分析.结果 ALD患者4项肝纤维化指标均高于健康对照组(均P<0.05);AIH组4项指标均高于病毒性肝炎组(均P<0.01),ROC曲线下面积分别为0.823、0.849、0.824和0.830; PBC组CⅣ和LN低于肝硬化组(P<0.05);两组ALD患者在经治疗6个月后,上述指标均明显下降(均P<0.05).结论 肝纤维化血清标志物HA、PCⅢ、CⅣ和LN对于ALD患者肝纤维化的诊断及和病毒性肝炎的鉴别具有一定价值,并能间接反映肝脏炎症的情况.     

Serum hyaluronan as a marker of liver fibrosis in asymptomatic chronic viral hepatitis B.

Increased concentrations of serum hyaluronan, a polysaccharide widely distributed in the extracellular space, have been demonstrated in liver disease of various aetiologies and proposed as a useful marker of liver fibrosis. The aim of the present study was to evaluate the association of serum hyaluronan with the extent of hepatic fibrosis in asymptomatic cases of chronic hepatitis B viral infection. The study was conducted in a consecutive sample of 111 asymptomatic chronic carriers of hepatitis B surface antigen. Liver function tests, alcohol consumption and cigarette smoking were determined and, for 84 subjects, liver biopsy was performed and degrees of inflammation and fibrosis were scored. Hyaluronan was measured using a radiometric assay. Mean serum hyaluronan increased with increasing fibrosis score (from 22.2 +/- 4.8 to 50.6 +/- 12.7 microg/l, p = 0.058) or pathological severity (from 18.8 +/- 5.9 to 50.6 +/- 12.5 microg/l, p = 0.048), even after adjusting for the effect of age. No such correlation was found with portal inflammation. The study showed that, in asymptomatic chronic carriers of hepatitis B, serum hyaluronan concentration correlates with hepatic fibrosis, a known marker of disease prognosis. This finding supports the hypothesis that hyaluronan might be of use in assessing and monitoring time trends in liver disease, substituting for repeated biopsies.     

Immunogenetic HLA markers of chronic viral hepatitis

AIM: To study possible immunogenetic HLA markers of chronic viral hepatitides. MATERIAL AND METHODS: Using the reaction of complement-dependent cytotoxicity by Terasaki, we analysed distribution of leukocytic HLA antigens (loci A, B and C) in 179 patients with chronic viral hepatitides B, C and D in Russians and Kazakhs living in the Astrakhan Region. RESULTS: In the Russian population we discovered a significant positive association of CVHB with HLA-B18, HLA-B35, HLA-B40, HLA-Cw3 antigens, and negative one--with HLA-A2. In Kazakhs with CVHB there was a positive association with HLA-A3, HLA-B18 and negative one--with HLA-A11. Alleles HLA-A10, HLA-B35, HLA-B40 and HLA-Cw3 mark CVHC in Russians. HLA-Cw4 specificity acts as protector in development of chronic HCV-infection. A correlation was found between carriage of some specificities and haplotypes of HLA and activity of chronic HBV and HCV infection. A high risk of chronic delta infection in Russians is associated with HLA-B8 and HLA-B35, in Kazakhs--with HLA-B35 and HLA-D40. There are significant associations between CVHB, CVHC, chronic delta infection and some HLA haplotypes. CONCLUSION: A universal role of HLA-B35 specificity in development of CVH irrespective of hepatotropic virus and patients' nationality is shown.