慢性乙型肝炎肝纤维化分期与血清肝纤维化标志物的相关性分析

目的 探讨血清透明质酸、Ⅲ型前胶原、层粘蛋白、Ⅳ型胶原等血清肝纤维化标志物与慢性肝炎肝组织炎症活动度及纤维化程度的相关性。方法 278例慢性肝炎患者经肝脏活栓后常规病理检查，肝活检前同时采血检测血清透明质酸、Ⅲ型前胶原、层粘蛋白、Ⅳ型胶原，结果应用x^2检验及t检验进行统计学处理。结果 肝组织纤维化程度与炎症活动度呈正相关关系，透明质酸可反映中度以上慢性肝炎炎症活动度及纤维化程度，且呈正相关；肝脏存在纤维化时层粘蛋白水平升高，与纤维化程度正相关；Ⅲ型前胶原、Ⅳ型胶原水平升高与炎症活动度有关。结论 血清透明质酸、Ⅲ型前胶原、层粘蛋白、Ⅳ型胶原可不同程度反映肝纤维纤维化程度，可作为血清肝纤维化检测指标，透明质酸更可反映肝硬化发展趋势。

Correlation between liver fibrosis stage and serum liver fibrosis markers in patients with chronic hepatitis B

OBJECTIVE: To evaluate the diagnostic value of serum liver fibrosis markers by analyzing the correlation between liver fibrosis stage in patients with chronic hepatitis B and serum liver fibrosis markers, such as hyaluronate, type III procollagen, laminin, and type IV collagen. METHODS: There were 278 patients with chronic hepatitis B in this series. Before liver biopsy, the serum was collected to test hyaluronate, type III procollagen, laminin, and type IV collagen. Data were analyzed statistically. RESULTS: Liver fibrosis stage was correlated to inflammation degree. In patients with moderate or serious liver inflammation and fibrosis, serum hyaluronate was above normal level, and correlated to liver inflammation and fibrosis. For patients with chronic hepatitis B, serum type III procollagen, laminin, and type IV collagen increased apparently. While laminin was correlated to liver fibrosis, type III procollagen and type IV collagen correlated to liver inflammation. CONCLUSIONS: Serum hyaluronate, type III procollagen, laminin, and type IV collagen could reflect the state of liver fibrosis. Hyaluronate may be a useful marker for liver cirrhosis.