慢性乙型肝炎患者肝组织病理学改变与血小板计数和血清肝纤维化指标的相关性研究

目的探讨慢性乙型肝炎患者肝组织炎症分级及纤维化分期与患者血小板计数和肝纤维化四项指标的关系,寻找能较好反映肝脏组织学损伤的无创检查指标。方法对136例慢性乙型肝炎患者行肝穿刺活检,并采集静脉血检测血小板计数及Ⅲ型前胶原(PC-III)、Ⅳ型胶原(CⅣ)、透明质酸(HA)和层粘连蛋白(LN),分别对以上5项指标与肝组织炎症分级及纤维化分期进行相关性检验。结果肝组织纤维化分期及炎症分级均与血小板计数呈负相关(r分别为-0.370和-0.356,P值分别为0.02和0.0003);肝组织纤维化分期及炎症分级与PC-Ⅲ、C-Ⅳ、HA和LN均存在明显正相关(r分别为0.414、0.390、0.419、0.393及0.426、0.375、0.548、0.343,P值均小于0.05)。结论血小板计数、Ⅲ型前胶原、Ⅳ型胶原、透明质酸和层粘连蛋白对预测慢性乙型肝炎患者的肝组织损伤程度有一定临床意义。

Correlation of liver pathological changes to blood platelet counts and serum fibrosis indices in patients with chronic hepatitis B

Objective To explore the relationship between liver fibrosis stages /inflammation grades and blood platelet counts and serum fibrosis indices in patients with chronic hepatitis B,and to find the better noninvasive indices for liver histological damage.Methods The liver fibrosis stages /inflammation grades in 136 CHB patients were confirmed by pathological examination using biopsy tissues.The blood platelet counts and serum fibrosis indices(pro-collagen III,collagen IV,hyaluronic acid,laminin) were tested in the patients.The correlation analysis was made between the aforementioned 5 indices and liver fibrosis stages /inflammation grades.Results Significant negative correlations were found between liver fibrosis stages /inflammation grades and blood platelet counts(Spearman r=-0.370 and-0.356,P=0.002 and 0.0003,respectively);However,significant positive correlations were found between the liver fibrosis stages /inflammation grades and liver fibrosis indices(Spearman r for PC-III,C-IV,HA,and LN were 0.414,0.390,0.419,0.393,and 0.426,0.375,0.548,0.343,respectively,all P < 0.05).Conclusions The blood platelets,PC-III,C-IV,HA,and LN may be used as an noninvasive markers for liver injuries in CHB patients.