婴儿肝炎综合征血清纤维化标志物临床价值研究

Clinical significance of serum fibrosis markers in diagnosis of infantile hepatitis syndrome

摘要:

目的 通过对婴儿肝炎综合征（IHS）患儿血清4项肝纤维指标及其与肝功能的相关性分析，初步探讨肝纤4项在IHS的临床应用价值及对疾病严重程度的评估。方法 回顾研究60例婴儿肝炎综合征患儿，根据超声诊断分为肝纤维化组（n=31）与非肝纤维化组（n=29），比较两组肝纤4项指标水平，包括透明质酸（HA），Ⅲ型前胶原（Pc-Ⅲ），Ⅳ胶原（Ⅳ.C），层粘连蛋白（LN）；并将4项肝纤维化指标与肝功能指标进行相关性分析。结果 肝纤维化组谷丙转氨酶（ALT）、总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）和胆汁酸（TBA）水平明显高于非肝纤维化组（P<0.05）；肝纤维化组HA、Ⅳ.C指标明显高于非肝纤维化组（P<0.05）。HA、Ⅳ.C及Pc-Ⅲ与ALT、GGT、TBIL、DBIL、IBIL、TBA成正相关（r=0.25~0.49），其中HA、Ⅳ.C与转氨酶及黄疸水平相关性最强，LN未发现有相关性指标。结论 血清4项肝纤维化标志物中HA、Ⅳ.C及Pc-Ⅲ联合肝功能及超声检查对IHS肝纤维化的早期诊断、评估病情有着重要临床价值。

Abstract:

Objective To investigate the correlation between four serum fibrosis markers and liver function in patients with infantile hepatitis syndrome (IHS), and to explore the clinical significance of these markers in the diagnosis of IHS and the assessment of disease severity. Methods A retrospective study was performed on 60 patients with IHS who were divided into hepatic fibrosis and normal groups based on ultrasound diagnosis. Levels of four liver fibrosis markers, i.e., hyaluronic acid (HA), type III procollagen (PC-III), type IV collagen (IV.C), and laminin (LN), were compared between the two groups, and the correlation between these markers and liver function was analyzed. Results Levels of liver function markers (alanine aminotransferase (ALT), glutamyl transpeptidase (GGT), total bilirubin (TBil), direct bilirubin (DBil), indirect bilirubin (IBil), and total bile acid (TBA)) in the hepatic fibrosis group were significantly higher than those in the normal group (P<0.05). Levels of HA and IV.C in the hepatic fibrosis group were significantly higher compared with those in the normal group (P<0.05). Furthermore, HA, IV.C, and PC-III levels were positively correlated with those of ALT, TBil, GGT, DBil, IBil, and TBA (r=0.25-0.49), and the strongest correlation existed between HA/IV.C and ALT/jaundice markers. Conclusions Assay measuring serum fibrosis markers (HA, IV.C, and PC-III) in combination with liver function tests and ultrasound examination has an important clinical value in the early diagnosis of IHS and evaluation of disease severity.