血清标志物在慢性肝病肝硬化诊断中的应用研究

目的 初步评价4项细胞外间质（ECM）指标包括透明质酸（HA）、Ⅳ型胶原（ColⅣ)、Ⅲ型胶原N端肽（PⅢNP）、层粘蛋白（LN）在肝硬化非创伤性诊断中的价值。方法 采用放射免疫（RIA）检测HA、PⅢNP、LN，酶联免疫吸附测定（ELISA）检测ColⅣ，比较这4项指标与病理检查结果即组织学炎症、纤维化分级、分期的相关性。结果 HA、ColⅣ在炎症不同级及纤维化不同期的检测水平随炎症及纤维化的进展而升高，且差异有显著意义。提示HA、ColⅣ 与炎症及纤维化改变程度有较好相关性。PⅢNP水平在一定程度上反映炎症轻度、重度的 变化，。但在纤维化不同期差异显著意义。LN在不同炎症及纤维化级期改变中差异均无显著意义，故不能反映炎症及纤维化性变化。结论 本研究中的4项ECM指标在肝硬化及炎症中的诊断价值以HA最高，其次为ColⅣ，其中HA不仅能反映慢性肝病的纤维化性和炎症性改变，对监测炎病和纤维化进展亦有较高价值。

Application of serum markers in the diagnosis of fibrotic liver disease

Objective　To investigate the application of hyaluronic acid (HA), collagen type Ⅳ (ColⅣ), N-terminal procollagen Ⅲ (PⅢNP) and laminin (LN) in the diagnosis of chronic fibrotic disease. Methods　HA, PⅢNP and LN were determined with RIA and ColⅣ with ELISA. Relationship between serum markers and histological grades of inflammation and fibrosis was evaluated. Results　Serum HA and ColⅣ elevated significantly with the progress of inflammation and fibrosis (P<0.01, P<0.05), indicating that there existed excellent correlation between HA or ColⅣ and histological grades. PⅢNP increased with the progress of inflammatory severity but no significant change was found in different fibrotic grades. Serum LN remained unchanged in different histological grades. Conclusion　HA and ColⅣ are of practical diagnostic value with the 4 serum markers investigated. The level of HA reflects not only the existence but also the progress of fibrotic or inflammatory change in chronic hepatic disease. The application of PⅢNP and LN for diagnostic use are not confirmed, indicating that further study is required for elucidation.