基于肝组织病理动态变化情况探讨血清学指标在肝纤维化诊断中的意义

目的基于药物干预前后的肝组织病理动态变化情况，探讨肝功能、肝纤维化血清学指标在慢性乙型肝炎肝纤维化诊断和预后判断中的价值。方法根据扶正化瘀胶囊抗慢性乙型肝炎肝纤维化多中心，随机、双盲，对照临床试验中93例（包括试验组和对照组）治疗6个月前后2次肝活体组织病理学检查的资料，并依据肝组织纤维化程度减轻和未减轻（或继续加重）的情况将病例分为两组（减轻组36例，未减轻组57例），分析该两组肝组织炎症、肝功能、肝纤维化血清学指标及相应的血常规变化规律。结果纤维化减轻组伴有肝组织炎症程度的显著减轻。药物干预后，纤维化减轻组的血清透明质酸和Ⅲ型前胶原肽含量明显下降（t=3．34与t=3．17，P值均〈0．01），并显著低于未减轻组；但层黏连蛋白和Ⅳ型胶原含量差异均无统计学意义。纤维化减轻组伴有血清白蛋白升高（t=3．24，P〈0．01）及γ-谷氨酰转肽酶，天冬氨酸氨基转移酶活性和凝血酶原时间的下降，而未减轻组无类似变化。结论慢性乙型肝炎肝纤维化患者血清γ-谷氨酰转肽酶，天冬氨酸氨基转移酶活性，凝血酶原时间，白蛋白、血清透明质酸和Ⅲ型前胶原肽含量的变化有助于肝纤维化减轻与否的判断和药物疗效评价，而血清层黏连蛋白和Ⅳ型胶原含量在肝纤维化诊断中的价值有待商榷。

The value of serum markers in evaluating liver fibrotic changes

OBJECTIVE: Serum fibrotic markers were investigated for diagnosing and prognosing liver fibrosis in chronic hepatitis B. METHODS: Liver biopsy data of 93 patients before and after treatment were gathered from an experiment group (Fuzhenghuayu capsule, 36 cases) and a control group (Heluoshugan capsule, 57 cases) from multiple medical centers, using randomized and double blind strategies to evaluate the effectiveness of Fuzhenghuayu capsules against liver fibrosis. The patients were divided into 2 groups according to the treatment efficacy: an effectual group and a non-effectual group. The hepatic inflammation, liver function and serum fibrotic markers of the patients of the two groups were analyzed. RESULTS: We found that (1) Liver fibrosis improved with hepatic inflammation improvement. (2) After the drug treatment, the serum HA and PIIIP levels of the effectual group decreased obviously (t = 3.34, t =3.17, P < 0.01), and the decreased degree was higher than that of the non-effectual group, but there were no changes for LN and IV-C levels. (3) Alb contents increased (t = 3.24, P < 0.01) and activities of GGT and AST and PT decreased significantly in the effectual group, but there was no change in the non-effectual group. CONCLUSION: The serum GGT and AST activities, PT, Alb, HA and PIIIP contents in the chronic hepatitis B patients are good markers for evaluating the degree of liver fibrosis and the effectiveness of the drug action, but the values of LN and IV-C in the evaluation need to be studied more.