【摘要】 目的 探讨血清纤维化指标透明质酸（ＨＡ）、Ⅲ型前胶原（ＰＣⅢ）、Ⅳ型胶原（ＣⅣ）定量对肝组织纤维化不同阶段诊断的临床应用价值。方法 用放射免疫法（ＲＩＡ）检测２５３例慢性肝病患者血清ＨＡ、ＰＣＰＣⅢ、ＣⅣ水平，所有患者同时做了肝组织活检。以病理诊断为金标准，采用ＲＯＣ（Ｒｅｃｅｉｖｅｒ Ｏｐｅｒａｔｉｎｇ Ｃｕｒｖｅ）曲线确立ＨＡ、ＰＣⅢ、ＣⅣ诊断肝纤维化（分期≥ Ｓ２）和肝硬化（分期Ｓ４）的截断值及其诊断的灵敏度（Ｓｅ）、特异度（Ｓｐｅ）、阳性预测值（ＰＰＶ）和阴性预测值（ＮＰＶ）。结果 血清ＨＡ、ＰＣⅢ、ＣⅣ诊断肝纤维化（分期≥Ｓ２）的截断值分别为９０μｇ／Ｌ、９０μｇ／Ｌ、７５μｇ／Ｌ，其诊断的灵敏度分别为８０．４％、８２．０％、６３．１％，特异度分别为７０．２％、６０．８％、８３．８％，阳性预测值（ＰＰＶ）分别为８６．７％、８３．５％、９０．４％，阴性预测值（ＮＰＶ）分别为５９．８％、５８．４％、４８．４％。ＨＡ、ＰＣⅢ、ＣⅣ诊断肝硬化的截断值分别为２１０μｇ／Ｌ、１５０μｇ／Ｌ、９０μｇ／Ｌ，其诊断的灵敏度分别为９６．２％、７６．４％、８０．０％，特异度分别为８５．３％、６８．７％、７５．８％，ＰＰＶ分?更多还原

【Abstract】 Objective To study the accurate diagnosis of various stages of hepatic fibrosis by measuring serum hyaluronic acid（HA), procollagen type Ⅲ（PCⅢ), and collagen type Ⅳ（CⅣ). Methods The concentrations of serum HA, PCⅢ, CⅣ in 253 patients with chronic liver disease were measured by radioimmunoassay. Liver biopsies were per- formed in all of the patients at the same time. According to the results of liver pathological diagnosis, we assessed the ability of serum HA, PCⅢ and CⅣ to identify correctly patients with hepatic fibrosis（staging ≥ S2) or cirrhosis（S4). Results The cutoff value of HA, PC Ⅲ and C Ⅳ to identify correctly patients with hepatic fibrosis was 90μg/L, 90μg/L, 75μg/L, respectively. The sensitivity（Se) was 80.4%, 82%, 63.1%; the specificity（Spe) was 70.2%, 60.8%, 83.8%; the positive prediction value（PPV) was 86.7%, 83.5%, 90.4%; the negative prediction value（NPV) was 59.8%, 58.4%, 48.4%, respectively. The cutoff value to identify patients with cirrhosis was: HA 210μg/L, Se 96.2%, Spe 85.3%, PPV 65.4%, NPV 98.8%; PC Ⅲ 150 μg/L, Se 76.4%, Spe 68.7%, PPV 40.4%, NPV 91.3%; C Ⅳ 90μg/L, Se 80%, Spe 75.8%, PPV 47.8%, NPV 93.2%, respectively. Conclusions The determination of serum HA, PC Ⅲ and C IV can make relatively accurate diagnosis to various stages of hepatic fibrosis. HA is the best for diagnosis of liver cirrhosis.更多还原