Park Jin Hyung, Park Chang Kun, Kim Eun Soo, Park Soo Young, Jo Chang Min, Tak Won Young, Kweon Young Oh, Kim Sung Kook, Choi Yong Whan
Department of Internal Medicine, Kyungpook National University, College of Medicine, Daegu, Korea.
Taehan Kan Hakhoe Chi. 2003 Jun;9(2):79-88.
BACKGROUND/AIMS: The prognosis of chronic liver disease is closely related to the development of hepatic fibrosis. Liver biopsy is the gold standard method to assess inflammatory activity and fibrosis stage, but this is associated with morbidity and mortality. This study aimed to evaluate the diagnostic value of serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis.
This study included 100 patients with chronic hepatitis B and cirrhosis. Liver biopsy and histopathologic classification were done. Serum hyaluronic acid and 7S domain of type IV collagen were measured by one step sandwich binding protein assay and radioimmunoassay using polyclonal antibody to 7S domain of type IV collagen, respectively.
The serum concentrations of hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio in the cirrhosis group (139 +/- 98.4 ng/mL, 6.9 +/- 3.5 ng/mL, 1.6 +/- 1.5) were significantly higher (p<0.01) than those in the normal and fatty liver group (20.2 +/- 12.5 ng/mL, 3.5 +/- 0.5 ng/mL, 0.7 +/- 0.3), mild hepatitis group (32.3 +/- 52.7 ng/mL, 3.9 +/- 1.4 ng/mL, 0.7 +/- 0.4), and moderate to severe hepatitis group (68.2 +/- 72.3 ng/mL, 5.3 +/- 2.4 ng/mL, 0.8 +/- 0.4). At the cutoff value of 77 ng/mL for hyaluronic acid and 6.3 ng/mL for 7S domain of type IV collagen and 0.62 for AST/ALT ratio, the sensitivities were 81.8%, 63.6%, 90.9% and specificities were 87.3%, 88.6%, 53.1% for discriminating cirrhosis (fibrosis score: 4) from the mild to severe fibrosis (fibrosis score: 0-3).
Serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio measurement may be clinically useful as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis.
背景/目的：慢性肝病的预后与肝纤维化的发展密切相关。肝活检是评估炎症活动和纤维化分期的金标准方法，但存在一定的发病率和死亡率。本研究旨在评估血清透明质酸、IV型胶原7S结构域及AST/ALT比值作为慢性乙型肝炎和肝硬化肝纤维化标志物的诊断价值。
本研究纳入100例慢性乙型肝炎和肝硬化患者。进行肝活检及组织病理学分类。血清透明质酸采用一步夹心结合蛋白法检测，IV型胶原7S结构域采用抗IV型胶原7S结构域多克隆抗体放射免疫法检测。
肝硬化组血清透明质酸、IV型胶原7S结构域及AST/ALT比值（分别为139±98.4 ng/mL、6.9±3.5 ng/mL、1.6±1.5）显著高于正常及脂肪肝组（20.2±12.5 ng/mL、3.5±0.5 ng/mL、0.7±0.3）、轻度肝炎组（32.3±52.7 ng/mL、3.9±1.4 ng/mL、0.7±0.4）及中重度肝炎组（68.2±72.3 ng/mL、5.3±2.4 ng/mL、0.8±0.4）（p<0.01）。以透明质酸77 ng/mL、IV型胶原7S结构域6.3 ng/mL及AST/ALT比值0.62为临界值，区分肝硬化（纤维化评分：4）与轻至重度纤维化（纤维化评分：0-3）时，敏感性分别为81.8%、63.6%、90.9%，特异性分别为87.3%、88.6%、53.1%。
检测血清透明质酸、IV型胶原7S结构域及AST/ALT比值可能在临床上作为慢性乙型肝炎和肝硬化肝纤维化的标志物具有实用价值。
