【摘要】 目的探讨血清肝纤维化标志物与超声联合检查在评价肝纤维化程度的应用价值。方法选择151例慢性肝炎患者,同时进行超声和血清肝纤维化标志物检测,并行肝组织病理活检。经统计学分析筛选出评价肝纤维化意义最大的三项超声独立性判别指标作为超声综合指标,将血清透明质酸、Ⅲ型前胶原、Ⅳ型胶原作为血清肝纤维化综合指标。以病理诊断为金标准,采用判别分析,分别用超声及血清综合指标判断肝纤维化程度及肝硬化,计算判断符合率。结果血清HA、PCⅢ、CⅣ诊断肝纤维化(分期≥S2)的Cutoff分别为98μg/L、94μg/L、84μg/L,其诊断的灵敏度分别为78.4%、80.0%、61.8%,特异度分别为72.1%、61.7%、84.2%。HA、PCⅢ、CⅣ诊断肝硬化的截断值分别为220μg/L、146μg/L、92μg/L,其诊断的灵敏度分别为95.2%、78.4%、78.0%,特异度分别为84.6%、68.1%、74.9%。超声评价肝纤维化意义最大的独立性判别指标分别是肝实质回声(LE)、肝包膜回声(Lsur)及胆囊壁厚度(GBT)。超声及血清肝纤维化综合指标与纤维化病理分期的相关系数相近,超声评价中度肝纤维化的符合率高于血清(P<0.01),但两者在判断肝纤维化的总符合率及轻、重度纤维化的符合率方面差异无显著性意义(P>0.05)。两者诊断肝硬化的准确性相近,差异无显著性意义,但超声判断活动性肝硬化的符合率低于血清,而判断静止性肝硬化的符合率高于血清,差异有显著性意义(P<0.05)。结论HA是最好的血清诊断指标,超声与血清肝纤维化标志物检查在判断肝纤维化程度及诊断肝硬化方面各有优缺点,可互为补充。更多还原

【Abstract】 Objective To compare ultrasonography with serology in evaluating fibrosis degrees and diagnosing liver cirrhosis. Methods The concentrations of serum HA, PCⅢ, CⅣ by radioimmunoassay and ultrasonography in 151 patients with chronic liver disease were measured. Liver biopsies were performed in all of the patients at the same time.Both ultrasonographic and serologic multiple variables were used to discriminate degree of liver fibrosis and cirrhosis by using discriminating analysis according to liver histopathological findings,and the discriminating accurate rates were also calculated. Serum hyalurionic acid,human procollagen and collagen typeⅣ were identified as multiple serum markers of fibrosis. Results The cutoff value of HA , PCⅢ and CⅣ to identify relative correctly patients with fibrosis (staging ≥S2) was 98μg/L, 94μg/L, 84μg/L,respectively, the sensitivity (Se) was 78.4%, 80.0%, 61.8%, respectively,and the specificity (Spe) was 72.1%, 61.7%, 84.2%, respectively. The cut off value to identify relative correctly patients with cirrhosis was: HA 220μg/L, the Se was 95.2%, Spe 84.6%; PCⅢ 146μg/L, the Se was 78.4%, Spe 68.1%; CⅣ 92μg/L, the Se was 78%, Spe 74.9%,respectively. Hepatic parenchymal echo patterns, liver surface and thickness of gallbladder wall were identified as the most importment three independent ones to diagnosis liver fibrosis. The correlation coefficients of sonographic multiple variables with fibrosis stages were close to that of serologic multiple variables.The general discriminating accuracy for fibrosis and for mild and heavy fibrosis between sonographi can dserologic variables had no significant difference(P>0.05),while the discriminating accuracy of sonographic variables for medium degree of fibrosis was higher than that of serologic variables(P<0.01).There was no significant difference between sonographic and serologic variables in diagnosing compensated liver cirrhosis. The discriminating accuracy of sonographic variables was higher than that of serologic variables in inactive liver cirrhosis, but lower inactive cirrhosis(bothP<0.05).Conclusions HA is the best variable for diagnosing liver cirrhosis. Ultrasonography and serum markers of fibrosis both have their own benefit and weakness in evaluating liver fibrosis degrees and liver cirrhosis ,they can supplement mutually.更多还原