Niu Airu, Qi Tonggang
Institute of Medical Sciences, The Second Hospital of Shandong University, Jinan, China.
Clinical Laboratory, Sanhe Yanjiao Second and Third Hospital, Langfang, China.
Ann Transl Med. 2022 Dec;10(24):1310. doi: 10.21037/atm-22-5010.
Liver fibrosis is a necessary stage for various chronic liver diseases to develop into cirrhosis. The detection of serum markers of liver fibrosis is a commonly used method for early screening of liver fibrosis, mainly including type IV collagen (IVC), hyaluronic acid (HA), laminin (LN), and type III procollagen (PCIII). However, the high cost of the instrument and the slow detection speed are not conducive to mass screening and detection of the population. In this study, the widely used biochemical platform was used to jointly detect the liver fibrosis marker IVC and aspartate aminotransferase (AST) and alanine aminotransferase (ALT), We investigated the feasibility of serum IVC combined with the AST and ALT ratio (AST/ALT ratio) as a marker for liver fibrosis.
A total of 81 patients with liver disease by clinical liver biopsy comprised the study group, and 50 healthy people who underwent physical examination in the study period were selected as the control group. Serum IVC, AST and ALT levels were detected by biochemical testing, AST/ALT ratio was calculated, and four serum markers of liver fibrosis (IVC, HA, LN, and PCIII) were measured by chemiluminescence. Moreover, imaging by color Doppler ultrasound (B-ultrasound) was performed for statistical analysis.
(I) Serum IVC and the AST/ALT ratio were significantly higher in the study group than in the control group (P<0.05). (II) The sensitivity of serum IVC combined with AST/ALT ratio detected biochemically and the four markers of liver fibrosis detected by chemiluminescence in the diagnosis of liver cirrhosis was 95.83%, 97.92%, without significant difference, but the specificity and accuracy of IVC + AST/ALT ratio in the diagnosis of liver cirrhosis were significantly higher (94.00%, 94.90%). (III) The detection rate of serum IVC + AST/ALT ratio for the diagnosis of early liver fibrosis was significantly higher than with imaging examination (45.45% 21.21%).
Serum IVC + AST/ALT ratio determined by biochemical analysis has high diagnostic accuracy in the diagnosis of liver fibrosis and liver cirrhosis, and is worthy of clinical application and promotion.
肝纤维化是各种慢性肝病发展为肝硬化的必经阶段。检测肝纤维化血清标志物是肝纤维化早期筛查的常用方法，主要包括IV型胶原（IVC）、透明质酸（HA）、层粘连蛋白（LN）和III型前胶原（PCIII）。然而，仪器成本高、检测速度慢不利于人群的大规模筛查和检测。本研究利用广泛应用的生化平台联合检测肝纤维化标志物IVC以及天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT），探讨血清IVC联合AST与ALT比值（AST/ALT比值）作为肝纤维化标志物的可行性。
选取经临床肝穿刺活检的81例肝病患者作为研究组，选取同期进行体检的50例健康人作为对照组。采用生化检测法检测血清IVC、AST和ALT水平，计算AST/ALT比值，采用化学发光法检测4种肝纤维化血清标志物（IVC、HA、LN和PCIII）。此外，采用彩色多普勒超声（B超）成像进行统计分析。
（I）研究组血清IVC和AST/ALT比值显著高于对照组（P<0.05）。（II）生化检测的血清IVC联合AST/ALT比值与化学发光法检测的4种肝纤维化标志物对肝硬化诊断的灵敏度分别为95.83%、97.92%，差异无统计学意义，但IVC+AST/ALT比值诊断肝硬化的特异度和准确度显著更高（94.00%、94.90%）。（III）血清IVC+AST/ALT比值诊断早期肝纤维化的检出率显著高于影像学检查（45.45%对21.21%）。
生化分析测定的血清IVC+AST/ALT比值对肝纤维化和肝硬化诊断具有较高的诊断准确性，值得临床应用和推广。
