Körner T, Kropf J, Gressner A M
Department of Internal Medicine II, Klinikum Suhl, Germany.
J Hepatol. 1996 Nov;25(5):684-8. doi: 10.1016/s0168-8278(96)80239-x.
BACKGROUND/AIMS: In a prospective study with a mean follow-up period of 12.5 +/- 3.5 months, we investigated the extracellular matrix components laminin and hyaluronan in serum for their diagnostic value in portal hypertension and in clinically severe complications of progressive liver cirrhosis.
In 38 patients with liver fibrosis (n = 4) and cirrhosis (Child A: n = 17, B: n = 7, C: n = 10), the serum concentrations of laminin and hyaluronan were determined. Portal hypertension was assessed by endoscopic control of the esophageal varices and by Doppler sonography of the portal blood flow.
Neither laminin nor hyaluronan correlated with portal hypertension, but highly significantly increased (p < 0.001) concentrations of 3.25 +/- 0.2 U/ml (laminin) and 493 +/- 248 ng/ml (hyaluronan) were found in patients with complications of liver cirrhosis when compared to those without complications (Ln: 2.13 +/- 0.26 U/ml, HA: 206 +/- 184 ng/ml). At cut-off levels of 2.6 U/ml (laminin) and 200 ng/ ml (hyaluronan), the diagnostic sensitivity and specificity for severe complications of liver cirrhosis was 0.71 and 0.86 (Ln) and 0.90 and 0.67 (HA), respectively. The positive predictive values were of 0.8 (laminin) and 0.6 (hyaluronan). The relative risk of patients presenting elevated concentrations of laminin or hyaluronan at the start of the study for later development of severe complications was 2.7.
Both parameters, especially serum laminin, can be used as prognostic markers in addition to the Child criteria in liver cirrhosis.
背景/目的：在一项平均随访期为12.5±3.5个月的前瞻性研究中，我们研究了血清中的细胞外基质成分层粘连蛋白和透明质酸在门静脉高压症以及进行性肝硬化临床严重并发症中的诊断价值。
测定了38例肝纤维化患者（n = 4）和肝硬化患者（Child A级：n = 17，B级：n = 7，C级：n = 10）血清中层粘连蛋白和透明质酸的浓度。通过内镜检查食管静脉曲张和门静脉血流多普勒超声评估门静脉高压症。
层粘连蛋白和透明质酸均与门静脉高压症无关，但与无并发症的患者相比，肝硬化并发症患者的层粘连蛋白浓度显著升高（p < 0.001），为3.25±0.2 U/ml，透明质酸浓度为493±248 ng/ml（无并发症患者：层粘连蛋白为2.13±0.26 U/ml，透明质酸为206±184 ng/ml）。当层粘连蛋白的临界值为2.6 U/ml、透明质酸的临界值为200 ng/ml时，对肝硬化严重并发症的诊断敏感性和特异性分别为0.71和0.86（层粘连蛋白）以及0.90和0.67（透明质酸）。阳性预测值分别为0.8（层粘连蛋白）和0.6（透明质酸）。在研究开始时层粘连蛋白或透明质酸浓度升高的患者后期发生严重并发症的相对风险为2.7。
除Child标准外，这两个参数，尤其是血清层粘连蛋白，可作为肝硬化的预后标志物。
