慢性乙肝肝组织病理、肝内Ⅳ型胶原免疫组化与血清肝纤维化指标联合检测对肝纤维化诊断的相关研究

目的探讨慢性乙型肝炎（CHB）肝组织病理学、肝内Ⅳ型胶原（CIV）免疫组化与血清肝纤维化指标联合检测对肝纤维化诊断的相关性。方法对104例CHB患者进行了肝组织病理学，肝内CIV免疫组化检测及病理图像定量分析和血清肝纤维化指标（CIV、PC Ⅲ及HA）的同步检测。结果慢性乙肝肝内CIV及血清CIV、PC Ⅲ和HA检测值均随肝病理损害及肝纤维化程度的加重而升高，经相关分析，其r值分别为0．995、0．985、0．980，P均〈0．01。结论①肝内CIV与血清CIV、PCⅢ、HA检测可作为肝纤维化诊断的重要指标：②CHB患者肝窦内CIV的检出，为血清CIV的检测提供了病理学的证据；③CHB患者肝纤维化的程度，随肝损害程度的加重而逐渐增强。

Clinical Values of Liver Pathology,Intra-Hepatic Type-IV Collagen,and Serum Indexes of Hepatic Fibrosis on Diagnosis of Hepatic Fibrosis

Objective To investigate the relationship between liver pathology, hepatic collagen type Ⅳ （CIV）, serum indexes of hepatopathologic lesion and fibrosis, and their significance in diagnosing liver fibrosis in chronic hepatitis B patients. Method 104 patients with chronic hepatitis B were examined. Liver pathology, hepatic CIV and liver pathology images were quantitatively analyzed. Serum hepatic fibrosis indexes such as CIV, precollagen type Ⅲ （PC Ⅲ） and hyaluronic acid （HA） were measured. Result The increase in the levels of hepatic CIV, serum CIV, PC Ⅲ , and HA were correlated with the pathological damage of the liver and the degree of fibrosis （r=0.995, 0.985, 0.980, respectively; P〈0.01）. Conclusion ① The levels of hepatic CIV, serum CIV, PC Ⅲ, and HA levels are the key parameters in diagnosing hepatic fibrosis. ② CIV in hepatic sinuses provided the pathologic basis for serum CIV detection. ③ Development of hepatic fibrosis is associated with liver damage.