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投稿时间：2019-12-07 网络发布日期：2020-07-20
投稿时间：2019-12-07 网络发布日期：2020-07-20
中文摘要: 目的 观察肝豆状核变性(HLD)肝硬化进展中血清肝纤维化四项水平的变化,探讨其在HLD肝硬化进展中的临床应用价值。
方法 选择2019年1月至8月收治的99例HLD患者为对象进行回顾性研究。根据B超检查HLD患者肝硬化声像分为三组:肝正常组18例,肝纤维化组61例,肝硬化组20例。磁微粒化学发光法检测HLD患者血清透明质酸(HA)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)与Ⅲ型前胶原N端肽(PⅢNP)水平。采用受试者工作曲线(ROC)分析与比较血清相关项目在HLD肝纤维化的早期发现与诊断中的临床应用价值。
结果 HLD患者肝纤维化组血清HA水平依肝正常组→肝纤维化组→肝硬化组之序呈递增(P<0.01),肝硬化组血清CIV水平高于肝纤维化组和肝正常组（P均<0.01），但血清LN和PⅢNP水平三组间差异均无统计学意义(P均>0.05);肝硬化腹水组血清HA水平明显高于无腹水组(P<0.05)。ROC曲线分析发现,血清HA 对HLD肝纤维化诊断的曲线下面积(AUC)为0.828,其cut-off值、敏感度与特异度分别为72.36 ng/ml 、75.41%和88.89%。
结论 肝纤维化四项中仅HA能够早期发现HLD患者肝纤维化及反映其肝硬化的进展情况,具有重要的临床应用价值。
Abstract:*Objective To observe the changes of four serum markers of liver fibrosis in the progression of liver cirrhosis in hepatolenticular degeneration (HLD) to explore their clinical application values.
Methods A total of 99 patients with HLD admitted from January to August 2019 were selected for a retrospective study.According to liver cirrhosis on ultrasonography,the patients were divided into normal liver group(n=18),liver fibrosis group (n=61) and cirrhosis group (n=20).Magnetic particles-based chemiluminescence was used to detect the serum levels of hyaluronic acid (HA),collagen Ⅳ (CⅣ),laminin (LN) and N-terminal peptide of type Ⅲ procollagen (PⅢNP) in HLD patients.The receiver operating characteristic(ROC) curve was used to analyze and compare the clinical value of serum related items in the early detection and diagnosis of hepatic fibrosis in HLD.
Results The level of serum HA in HLD patients with liver fibrosis increased in the order of liver normal group,liver fibrosis group and liver cirrhosis group (P<0.01),the level of serum CⅣ in liver cirrhosis group was higher than that in liver fibrosis group and liver normal group (all P<0.01),and the level of serum LN and PⅢNP had no significant difference among the three groups (all P>0.05).
Serum HA level in liver cirrhosis group was statistically higher in patients without cirrhosis ascites (P<0.05).ROC curve analysis showed that AUC of serum HA in the diagnosis of liver fibrosis in HLD was 0.828,and its cut-off value,sensitivity and specificity were 72.36 ng/ml,75.41% and 88.89% respectively.
Conclusion Among the four serum markers of liver fibrosis,only HA can detect liver fibrosis in HLD patients early and reflect the progress of liver cirrhosis,which plays an important role in clinical application.sup>Department of Clinical Laboratory,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei,Anhui 230031,China
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基金项目:国家自然科学基金面上项目(81774299)
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引用文本：
张波克,周导,朱俊,等.血清肝纤维化四项在肝豆状核变性肝硬化进展中的变化及临床价值[J].中国临床研究,2020,33(7):900-903.
张波克,周导,朱俊,等.血清肝纤维化四项在肝豆状核变性肝硬化进展中的变化及临床价值[J].中国临床研究,2020,33(7):900-903.