瘀血阻络型慢性乙型肝炎患者胶原四项与病理分期的相关性研究

Correlation between four indicators of collagen and pathological stage in patients of chronic hepatitis B with blood stasis-obstructing collaterals

关键词:  慢性乙型肝炎  瘀血阻络  胶原四项  病理分期

Key words:  chronic hepatitis B  syndrome of blood stasis obstructing the collaterals  four indicators of liver fibrosis  pathological staging

摘要:

[目的] 分析瘀血阻络型慢性乙型肝炎患者血清透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)与肝组织病理分期的关系。[方法] 采用放射免疫分析技术测定30例经临床确诊为瘀血阻络型及30例肝郁脾虚型慢性乙型肝炎患者的HA、LN、PCⅢ及Ⅳ-C的水平,同时对两组慢性乙型肝炎患者进行肝脏病理检测,评估肝组织炎症及纤维化程度。[结果] 瘀血阻络型慢性乙型肝炎患者胶原四项水平明显升高,其肝脏病理主要G₃～G₄和S₃～S₄范围;肝郁脾虚型患者的血清HA和Ⅳ-C明显升高,其肝脏病理主要在G₀～G₂和S₀～S₂范围。[结论] 瘀血阻络型慢性乙型肝炎患者HA和Ⅳ-C水平升高,肝脏炎症及纤维化程度较重,且两者呈正相关,LN及PCⅢ作为诊断肝纤维化初期的指标不甚敏感。

Abstract:

[Objective] To analyze the correlation between four indicators of liver fibrosis and the pathological stage in chronic hepatitis B patients with syndrome of blood stasis obstructing the collaterals. [Methods] We collected 60 patients diagnosed as chronic hepatitis B, and 30 patients had syndrome of blood stasis obstructing the collaterals and 30 patients had syndrome of hepatic stagnation and spleen deficiency. We checked their HA, LN, PCⅢ and Ⅳ-C by radioimmunoassay and observed the pathological changes simultaneously to evaluate their liver inflammation and fibrosis level. [Results] The levels of PCⅢ, HA, LN and Ⅳ-C in patients with syndrome of blood stasis obstructing the collaterals were significantly elevated and the liver pathological stage ranges mainly from G₃～G₄ to S₃～S₄. The levels of HA and Ⅳ-C in patients with syndrome of hepatic stagnation and spleen deficiency were elevated significantly and their liver pathological ranges mainly from G₀～G₂ to S₀～S₂. [Conclusion] The levels of HA and Ⅳ-C in patients with syndrome of blood stasis obstructing the collaterals were elevated. The degree of liver inflammation and fibrosis was severe with positive correlation. LN and PCⅢ, as the primary diagnostic indicators of liver fibrosis, are still not sensitive enough.