联合检测细胞外基质因子对肝纤维化定量诊断方法的研究

摘要

目的通过对血清中常见的多种细胞外基质因子的检测,创建一种无创、简便易行的定量诊断肝纤维化的方法.方法以肝活检为肝纤维化诊断的金标准,同时检测肝纤维化和正常对照者血清中的透明质酸、层黏连蛋白、纤黏连蛋白、血清Ⅳ型胶原、血清Ⅲ型前胶原氨基端肽和血清脯氨酸肽酶,将两种方法检测的结果进行拟合优度检验,建立起用多种细胞外基质因子预测肝纤维化的多元Logistic回归方程.结果肝硬化组和慢性乙型肝炎(重度)以上各指标均无显著差别,慢性乙型肝炎(重度)＞慢性乙型肝炎(中度、轻度)＞正常对照.透明质酸、层黏连蛋白、血清Ⅳ型胶原、血清Ⅲ型前胶原氨基端肽和血清脯氨酸肽酶各因素均进入回归方程.以回归方程预测的肝纤维化T值大于0.95者做判断肝纤维化的标准,结果该法诊断的灵敏度和特异度分别为86.7%和80.0%,符合率为85%.结论肝细胞基质透明质酸、层黏连蛋白、纤黏连蛋白、血清Ⅳ型胶原、血清Ⅲ型前胶原氨基端肽和血清脯氨酸肽酶是诊断肝纤维化的敏感指标,联合检测可以对肝纤维化进行定量预测诊断.%Objective To build diagnosis of liver fibrosis formula by combination detection some extra cellular matrixes.Methods Liver biopsy were used to gold standard of diagnosis liver fibrosis,serum fibrosis markers of liver fibrosis group and normal control group were detected.There are differentiate parameters between two groups in single factors analysis were used to for evaluated by logistic regression analysis,and building logistic regression equation.Results There was no difference between liver cirrhosis and severe chronic B liver disease(P＜0.05),but there was a significant difference among severe and middle chronic B liver disease and normal control group.The regression equation of some parameters was established,the sensitive and specification of regression evaluation diagnosis liver fibrosis were 86.7% and 80.0% respectively.Conclusion The combination of noninvasive parameters is more valuable than single parameter in the diagnosis of liver fibrosis,and having build regression evaluation by detect extra cellular matrixes can be progress liver fibrosis.