【摘要】 目的 探究Ⅲ型前胶原N端肽（PⅢNP）在早期肝纤维化无创诊断和治疗效果评估中的应用价值。方法 选择2024年1月至9月收治的212例行肝脏穿刺活检患者进行回顾性分析，按照不同肝纤维程度分为S1～S2期肝纤维化组（n=131）和S3～S4期肝纤维化组（n=81），另选无肝纤维化的105例非酒精性脂肪肝患者、91例酒精性脂肪肝患者以及97例体检健康人员分别作为非酒精性脂肪肝组，酒精性脂肪肝组和体检健康组，比较各组血清肝纤维化指标[PⅢNP、透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(C-Ⅳ)]水平，并分析其对早期肝纤维化的诊断价值及与治疗效果的关系。结果 治疗前2组肝纤维化患者血清PⅢNP、HA、LN、C-Ⅳ水平均高于体检健康组、非酒精性脂肪肝组和酒精性脂肪肝组，且S3～S4期肝纤维化组高于S1～S2期肝纤维化组（P<0.05）。受试者工作特征曲线分析显示，PⅢNP诊断S1～S2期肝纤维化的曲线下面积（AUC）、敏感度、特异度分别为0.822、70.23%、84.53%，其AUC高于HA(0.781)、LN(0.733)、C-Ⅳ（0.752）;PⅢNP诊断S3～S4期肝纤维化的AUC、敏感度、特异度分别为0.791、72.84%、74.05%，其AUC高于HA(0.714)、LN(0.729)、C-Ⅳ（0.755）。治疗后6个月有61例患者复查，Spearman相关性分析显示，治疗后肝纤维化分期与血清PⅢNP、HA、LN、C-Ⅳ均呈正相关（P<0.001）。结论 PⅢNP是早期肝纤维化辅助诊断的良好指标，对患者病情进展评估及疗效监测具有一定的临床应用价值。更多还原

【Abstract】 Objective To explore the application value of procollagen type Ⅲ N-terminal peptide(PⅢNP) in the non-invasive diagnosis and therapeutic effect evaluation of early-stage liver fibrosis. Methods A retrospective analysis was conducted on 212 patients who underwent liver biopsy from January to September 2024. They were divided into the S1-S2 liver fibrosis group(n=131) and the S3-S4 liver fibrosis group(n=81) according to different degrees of liver fibrosis. Another 105 patients with non-alcoholic fatty liver disease without liver fibrosis, 91 patients with alcoholic fatty liver disease and 97 healthy physical examination were selected as the non-alcoholic fatty liver disease group, the alcoholic fatty liver disease group and the healthy physical examinee group, respectively. The levels of serum liver fibrosis indicators [PⅢNP, hyaluronic acid(HA), laminin(LN), type Ⅳ collagen(C-Ⅳ)] in each group were compared, and their diagnostic value for early-stage liver fibrosis and their relationship with therapeutic effects were analyzed. Results Before treatment, the levels of serum PⅢNP, HA, LN and C-Ⅳ in patients with liver fibrosis in both groups were higher than those in the healthy physical examination group, the non-alcoholic fatty liver disease group and the alcoholic fatty liver disease group, and the levels in the S3-S4 liver fibrosis group were higher than those in the S1-S2 liver fibrosis group(P<0.05). Receiver operating characteristic(ROC) curve analysis showed that the area under the ROC curve(AUC), sensitivity and specificity of PⅢNP in diagnosing S1-S2 liver fibrosis were 0.822, 70.23% and 84.53% respectively, and its AUC was higher than that of HA(0.781), LN(0.733) and C-Ⅳ(0.752) alone. The AUC, sensitivity and specificity of PⅢNP in the diagnosis of S3-S4 liver fibrosis were 0.791, 72.84% and 74.05% respectively, and its AUC was higher than that of HA(0.714), LN(0.729) and C-Ⅳ(0.755) alone. At 6 months after the treatment, 61 patients were reexamined. Spearman correlation analysis showed that liver fibrosis stage after treatment was positively correlated with serum PⅢNP, HA, LN, and C-Ⅳ(P<0.001). Conclusion PⅢNP is a good indicator for the auxiliary diagnosis of early-stage liver fibrosis and has certain clinical application value in the evaluation of disease progression and therapeutic effect monitoring of patients.更多还原