复方中药对肝纤维化治疗前后的血清学评价

目的通过对肝纤维化复方中药治疗的前后对比，结合肝病理组织学改变，进一步了解血清纤维化指标的诊断价值。方法对临床确诊为慢性乙肝及早期肝硬化的３４例患者，服用复方中药制剂半年，治疗前后各肝穿一次及采血４次，血清检测透明质酸（ＨＡ），Ⅲ型前胶原（ＰＣⅢ）Ⅳ型胶原（ＣＩＶ）及层粘素（ＬＮ）。ＨＡ、ＰＣⅢ及ＬＮ用放免法，ＣＩＶ用酶免法。结果治疗前后对比，血清纤维化指标中，ＨＡ、ＰＣⅢ及ＩＮ变化非常显著（Ｐ＜０００１）；ＣＩＶ变化不明显（Ｐ＞００５）；血清纤维化四项指标与病理炎症及纤维化程度关系密切。与炎症计分的相关系数为：ＰＣⅢ：（０５２８５）、ＨＡ（０３８７７）、ＣＩＶ（０３４６４）和ＬＮ（０３３４１）；与纤维化计分的相关系数为：ＨＡ（０６２０３）、ＬＮ（０４２８９）、ＰＣⅢ（０４０９８）和ＣＩＶ（０３９７７）。结论血清纤维化指标为较好反映肝纤维化的指标，并随治疗有效而下降，其中ＨＡ对肝纤维化及早期肝硬化的诊断价值较大，ＰＣⅢ更倾向于反映活动性肝纤维化。

Serological value of liver fibrosis before and after the treatment by compound medicinal herbs

Aim To assess the diagnostic value of the serum fibrosis markers and liver pathologic changes in liver fibrosis before and after the treatment by compound medicinal herds. Methods 34 cases of chronic hepatitis B and early cirrhosis with clinic diagnosis were given compound medicinal herbs for six months.Two liver biopsies and four blood samples were performed before and after the treatment.Fibrotic markers HAPCCIV and LN measured.HAPC and LN were determined with RIA.CIV was determined with EIA. Results The level of serum fibrosis markers was reduced very significantly at the and of therapy (P<0.001),but the change of CIV was not remarkable(P>0.05).Serum concentrations of HAPCCIV and LN significantly correlated with liver histological findings.The correlation coefficient between serum concentration of the fibrosis markers and inflammation scores were PC(0.5285)HA(0.3877)CIV(0.3464) and LN(0.3341) respectively.The correlation coefficient between the concentration of serum markers and fibrosis scores for HALNPC and CIV were 0.62030.42890.4098 and 0.3977 respectively. Conclusion Serum levels of HAPCCIV and LN were strongly correlated with degree of liver fibrosis,But there were some differences among them for diagnosing fibrosis.HA was more sensitive and specific than others.PC tended to represent active hepatic fibrogenesis.