肝纤维化诊断中肝穿病理分期及非创伤性指标相关性的研究.docVIP

肝纤维化诊断中肝穿病理分期及非创伤性指标相关性的研究 　　[摘要] 目的 评价肝纤维化非创伤性指标对诊断肝纤维化的应用价值。方法 测定122例慢性肝炎病人的血清肝纤维化指标,肝脏B超检查,并对肝活检组织学检查进行比较,以建立非创伤性指标对肝纤维化的诊断优势。结果 超声检查对门脉高压性肝硬化的诊断价值已肯定,但对轻、中度肝纤维化患者超声检查的指标的变化还不很显著,随着肝纤维化分期的上升,透明质酸(HA)、Ⅲ型胶原(PCⅢ)、Ⅳ型胶原(CⅣ)、层黏连蛋白(LN)的水平也随之增高,其水平与肝纤维化分期呈正相关。结论 血清肝纤维化相关标志结合B超检查门静脉主干内径、脾长径及脾静脉内径对肝纤维化有良好的诊断价值,联合检测结果与肝纤维化病理分级有一定的相关性。 　　[关键词] 肝纤维化;超声检查;血清学指标 　　[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-9701(2010)12-32-02 　　 　　Correlation of Liver Pathological Staging with Non-invasive Indexes in Diagnosis of Hepatic Fibrosis 　　LI Jichang1DUN Guoliang2 　　1. Digestion Medicine,Baoji Municipal Central Hospital,Baoji 721008 China;2. Function Department,Baoji Municipal Central Hospital,Baoji 721008,China 　　 　　[Abstract] Objective To evaluate the applied value of the liver fibrosis non-invasive indexes in the diagnose of liver fibrosis. Methods The serum liver fibrosis indexes were measured and liver B-ultrasound was carried out in 122 cases of chronic hepatitis and the histological examination of liver biopsy was compared in an attempt to establish the advantages of non-invasive indexes in the diagnosis of liver fibrosis. Results Liver B-ultrasound proved to be effective in the diagnosis of portal vein high pressure cirrhosis,but its effect was not obvious on the index changes of ultrasonic examination in mild and moderate liver fibrosis. The hyaluronic acid(HA),type Ⅲ collagen(PCⅢ),type IV collagen(CIV) and laminin(LN) levels were also increased with the increase in liver fibrosis staging,with a positive relation of the levels to the liver fibrosis staging. Conclusion Serum liver fibrosis related indexes with liver B-ultrasound show a good diagnostic value in the examination of portal vein trunk diameter,spleen length and spleen vein diameter. The combined check results are related to liver fibrosis pathological staging. 　　[Key words] Liver fibrosis;B-ultrasound;Serum indexes 　　肝纤维化是一种病理概念,又是一组临床和病理学的综合征,肝穿刺活体组织学检查是诊断肝纤维化和肝硬化的金标准[1,2]。但肝穿刺活检技术有一定局限性,慢性肝炎病变虽为弥漫性,但肝纤维化尤其肝硬化