血液生化学与1H磁共振波谱分析在兔肝纤维化中的诊断效能及相关性分析

目的探讨血清肝纤维化标志物和1H磁共振波谱分析（1H-MRS）指标在兔肝纤维化中的诊断效能及相互关系。方法健康新西兰大白兔45只，随机分为6组：第1组为对照组，5只；第2-6组为实验组，每组8只，共40只。对以四氯化碳（CC14）诱导产生的肝纤维化实验组兔和对照组兔行血清肝纤维化标志物和lH．MRS检查。血清学指标包括透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（C．Ⅳ）和层黏连蛋白（LN），1H-MRS参数为胆碱峰高choAmp、胆碱面积choAre、胆碱／脂质峰高比值（cho／lipid）Amp和胆碱／脂质面积比值（cho／lipid）Are。以病理学肝纤维化分期S≥1为判断阳性的标准，应用受试者工作特性曲线（ROC）评价两者各诊断指标在肝纤维化中的诊断效能，同时行血清学和1H-MRS指标间的相关性分析。结果ROC曲线下面积血清HA（0．893）〉C-Ⅳ（0．804）〉LN（0．732）〉PCⅢ（0．643），1H-MRS中依次为（cho／lipid）Amp（0．753）〉（cho／lipid）Are（0．742）〉choAre（0．544）〉choAmp（0．497）；除choAmp外，所有指标的曲线下面积、灵敏度和特异度均在0．5-0．9之间。choAmp、choAre与C-IV之间存在显著正相关（P〈0．01），choAre、（cho／lipid）Are与LN存在正相关（P〈0．05），（Cho／lipid）Amp与血清学各指标间无相关性。结论血清肝纤维化标志物和1H．MRS在诊断肝纤维化中能力相仿．但无灵敏度和特异度俱佳的诊断指标。两者之间存在的相关关系可能与间质纤维化影响代谢物的交换和排出有关。

Comparison and correlation between blood biochemistry and 1H-MR spectroscopy in the diagnosis of liver fibrosis inrabbits

Objective To investigate the value of serum fibrosis markers and 1H MR spectroscopy （1H-MRS） parameters and the relationship between them in the diagnosis of liver fibrosis in rabbits. Methods Fourty-five healthy Newland rabbits were divided into six groups randomly： No 1 as control group with 5 rabbits, No 2 to 6 as experimental group with 8 rabbits each. Rabbits with liver fibrosis induced with CC14 and controls were sampled blood preparation and performed 1H-MRS. Serum fibrosis markers includ- ed hyaluronic acid （HA）, procollagen type Ill （PC Ⅲ ）, type IV collagen （C-IV） and laminin （LN）. The peak amplitude and peak area of choline （choAmp, choAre） as well as the relative choline-to-lipid ratio of peak amplitude and peak area （eho/lipid）Amp, （eho/lipid）Are） were included as 1H-MRS parameters. Receiver operating characteristic （ROC） curve was used to evaluate the diag- nostic performance of all indices. The relationship between serum fibrosis markers and IH-MRS parameters were analyzed. Results Area under the curve （AUC） of serum fibrosis markers were in the order of HA（0.893）〉C-IV（0.804）〉LN（0.732）〉PC m （0.643）and AUC of 1H-MRS parameters were in the order of （cho/lipid）Amp （0.753）〉（cho/lipid） Are （0.742）〉 choAre （0.544）〉 choAmp （0.497）, respectively. Except of choAmp, the AUC, sensitivity and specificity of all indices were between 0.5 and 0.9. There was positive correlation between choAmp, ehoAre and C-IV （both P〈0.01 ） as well as choAre （cho/lipid） Are and LN （P〈0.05）. No re- lationship was found between （cho/lipid）Amp and serum indices. Conclusion Serum fibrosis markers and 1H-MRS parameters are of similar ability in diagnosing liver fibrosis, but no index has the best sensitivity and specificity. The correlation between them could reflect the disturbans of excretion of metabolites by excellular matrix accumulation in liver fibrosis.