Objective To investigate the applications of serum fibrosis index and liver function in patients with chronic hepatitis B (CHB) and its diagnostic value in liver fibrosis.Methods One hundred and twenty cases of CHB patients and 100 cases of healthy subjects were selected from October 2015 to October 2016.The serum fibrosis indexes[hyaluronic acid (HA), laminin (LN), type Ⅲ procollagen peptide (PⅢP) and type Ⅳ collagen (CⅣ)]and serum liver function indexes of [Total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT) and aspartate aminotransferase (AST)]of two groups were determined.The relationship between serum fibrosis index and liver function was analyzed.The application of serum specific fibrosis markers in the diagnosis of hepatic fibrosis in CHB patients was analyzed by ROC curve.Results The Serum fibrosis indexes (HA, LN, PⅢP, CⅣ) and liver function (TBil, DBil, ALT, AST) of CHB group were higher than those in control group (t=5.236,t=6.789,t=7.852,t=9.236,t=10.123,t=11.425,t=6.023,t=5.456,P<0.01).Serum fibrosis indexes (HA, PⅢP, CⅣ) and liver function (TBil, DBil) of S1-S2 group were higher than S3-S4 group (t=6.140,t=6.825,t=7.114,t=8.236,t=9.012,P<0.05).With the increase of fibrosis, serum ALT and AST levels were significantly decreased (t=6.122,t=5.825,P<0.05).There was no statistically significant difference in LN among all grades (P>0.05).There was a negative correlation between HA, PⅢP, CⅣ and ALT and AST (r=0.326,r=0.345,r=0.318,r=0.318,r=0.330,r=0.310,P<0.05), but there was no correlation between ALT,AST and ALT (r=0.116,r=0.123,r=0.102,r=0.112,P>0.05), but HA, PⅢP and CⅣ were positively correlated with TBiL and DBi in Spearman's correlation analysis (r=0.312,r=0.305;r=0.308,r=0.343,P<0.05).The results of ROC analysis showed that the area under the ROC curve (AUC): CⅣ (0.872)> HA (0.710)> PⅢP (0.523)> LN (0.485) was significantly higher than that of single diagnostic value of a high index.Conclusion The serum fibrosis index is closely related to the changes of liver function in patients with CHB.Serum HA and C Ⅳ can be used as predictors of liver fibrosis.%目的 探讨血清纤维化标志物和肝功能指标在慢性乙型肝炎(CHB)患者肝纤维化诊断中的价值.方法 选取2015年10月-2016年10月成都市公共卫生临床中心收治的120例CHB患者(CHB组),另选取100例健康体检者作为健康对照组,测定2组血清纤维化标志物[透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)]和血清肝功能指标[总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、天门冬氨基酸转移酶(AST)]水平,并将对CHB患者进行纤维化分期,应用Spearman单因素分析血清纤维化标志物与肝功能指标的关系,根据受试者工作特征曲线(ROC)分析血清纤维化标志物在CHB肝纤维化诊断中的应用价值.结果 CHB组血清纤维化标志物(HA、LN、PⅢP、CⅣ)及肝功能指标(TBil、DBil、ALT、AST)水平均高于健康对照组(P均<0.01).CHB纤维化分期S3~S4级血清纤维化标志物(HA、PⅢP、CⅣ)及肝功能指标(TBil、DBil)均高于S1~S2级(P均<0.05),而随着纤维化程度增加,血清中ALT、AST水平显著下降,纤维化分期S3~S4级低于S1~S2级(P<0.05),而各分级中LN比较差异无统计学意义(P>0.05).经Spearman相关性分析显示,HA、PⅢP、CⅣ与ALT、AST均呈负相关(P<0.05),而LN与TBil、DBil、ALT、AST无相关性(P>0.05),HA、PⅢP与TBil、DBil均呈正相关(P<0.05).经ROC分析可见,ROC曲线下面积(AUC)CⅣ> HA>PⅢP>LN,血清HA、CⅣ联合诊断早期肝硬化(S1~S2)的价值较单一指标诊断价值高.结论 血清纤维化标志物与CHB患者肝功能变化有密切的关系,其中血清HA、CⅣ可作为肝纤维化的预测指标.
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