慢性乙型肝炎患者血清MMP-2和TIMP-2水平及超声检查指标评估肝纤维化分期意义探讨*

目的 探讨超声检查门静脉指标及血清基质金属蛋白酶-2（MMP-2）和金属蛋白酶组织抑制因子-2（TIMP-2）变化在慢性乙型肝炎（CHB）患者肝纤维化分期中的诊断价值。方法 2014年5月~2018年5月我院收治的CHB患者43例和同期健康体检者40例,使用超声B超检查测定门静脉宽度、脾静脉宽度和脾脏厚度,采用ELISA法检测血清MMP-2和TIMP-2水平,采用微孔板单光子计数仪检测血清透明质酸（HA）、层粘连蛋白（LN）、Ⅳ型胶原蛋白（IV-C）和III前胶原氨基端肽（P III P）水平。常规行肝穿刺活检。结果 肝穿组织病理学检查提示,S0~S1患者13例,S2患者11例,S3患者14例和S4患者5例;自S2期到S4期,随着肝纤维化程度的不断加重,患者门静脉宽度、脾静脉宽度和脾脏厚度不断增大,差异具有统计学意义（P<0.05）;S0~1、S2、S3和S4期患者血清MMP-2水平分别为（291.5±35.3） mg/L、（357.7±32.5） mg/L、（446.8±47.1） mg/L和（595.3±85.4） mg/L,血清TIMP-2水平分别为（154.3±28.6） mg/L、（210.7±24.1） mg/L、（255.7±31.9） mg/L和（302.5±74.3） mg/L,均显著高于健康人分别为（246.5±32.1） mg/L和（126.5±20.1） mg/L,P<0.05];存在显著肝纤维化的CHB患者血清HA、LN、IV-C和P III P水平显著高于健康人（P<0.05）,且随着肝纤维化加重而逐渐升高。结论 超声检测门静脉指标联合血清指标检测将有助于对CHB患者肝纤维化程度的判断,对诊断和治疗疗效的判断可能具有指导意义。

Significance of portal vain parameters by ultrasonography and serum MMP-2 and TIMP-2 detection in evaluation of liver fibrosis in patients with chronic hepatitis B

Objective To investigate the diagnostic value of portal vain by ultrasonography and serum matrix metalloproteinase-2 （MMP-2） and tissue inhibitor of metalloproteinase-2（TIMP-2） in patients with chronic hepatitis B （CHB）.Methods Forty-three patients with CHB and 40 healthy controls were enrolled in our hospital between May 2014 and May 2018,and all patients underwent liver biopsy for liver fibrosis staging. B-ultrasound was performed in all subjects,and the width of portal vein, the width of the splenic vein,and the thickness of the spleen were measured. Serum MMP-2 and TIMP-2 levels as well as hyaluronic acid （HA）,laminin （LN）,type IV collagen（IV-C） and III procollagen amino terminal peptide （P III P） were assayed.Results Liver biopsy results showed that there were 13 patients with S0-S1,11 patients with S2,14 patients with S3,and 5 patients with S4;From S2 to S4 with the increasing degree of liver fibrosis,the portal vein width,splenic vein width and spleen thickness increased gradually,and the differences between patients with different liver fibrosis was statistically significant（P<0.05）;Serum MMP-2 levels in patients with S0-1,S2,S3 and S4 were（291.5±35.3） mg/L,（357.7±32.5） mg/L,（446.8±47.1） mg/L and （595.3±85.4） mg/L,and serum TIMP-2 levels were （154.3±28.6）mg/L,（210.7±24.1） mg/L,（255.7±31.9） mg/L and （302.5±74.3） mg/L,significantly higher than（246.5±32.1） mg/L and （126.5±20.1） mg/L（P<0.05） in healthy persons;serum HA,LN,IV-C and P III P levels in patients with significant liver fibrosis were higher than those in healthy control （P<0.05）. Conclusion The examination of portal vain parameters by ultrasonography and serum liver fibrosis determination might help predict the intrahepatic liver fibrosis in patients with CHB.