liver fibrosis examination, liver fibrosis diagnosis

liver fibrosis examination, liver fibrosis diagnosis

  • 2021-07-26 13:35:19
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Common examination of liver fibrosis

Check nameInspection siteInspection departmentCheck function
HyaluronidaseLiverHepatobiliaryClinically used as a drug...
Examination of liver fibrosis indexBlood vesselHepatobiliaryHepatic fibrosis markers...
Test reflecting hepatic interstitial changesLiverHepatobiliaryFor the diagnosis of liver function...
Serum total proteinBlood vessel--Total serum protein is...
UrobiliaryHepatic blood vesselNephrogynecological painUrinary gallbladderOriginal (URO)...
CT of liver, gallbladder and spleenHepatobiliaryHepatobiliaryLiver, gallbladder, spleen CT...
B-ultrasound of liverLiver--Liver B-ultrasound helps...
Ratio of serum albumin to globulinLiverKidney hepatitis liver diseaseThe white/ball ratio is...
Serum fibronectinLiver whole body--By testing the serum...
Serum type ⅳ collagenLiver--Type ⅳ collagen is the main...
Serum lamininLiver--Serum human laminae...
Liver fibrosis examination

I "laboratory inspection

1. Indicators of extracellular matrix metabolism

(1) Detection of enzymes involved in collagen and matrix metabolism:

Proline 4-hydroxylase

(proline-4-hydRoxylase, PH): PH is a glycoprotein, and serum PH level is related to the degree of liver fibrosis. However, non-liver fibrosis, such as obstructive aundice, can also increase. Now, PH β submonoclonal antibodies have been prepared, and the serum PH content has been detected by immunological methods, which improves the sensitivity by about 20 times.

② Monoamine oxidase (MAO): MAO participates in the cross-linking of collagen, which makes the soluble collagen fibers covalently cross-linked within molecules, thus forming insoluble collagen fibers. The increase of MAO activity in serum is parallel to the degree of liver fibrosis. It is found that there are four isozymes of MAO, among which MAO1 is obviously increased during liver fibrosis, but the sensitivity of MAO determination is low and the operation is complicated, so it can not be widely used.

③ P-Z peptidase: This enzyme is an endonuclease, and its activity can be used as an index of collagen degradation, which is often detected at the same time as P-ⅲ-P. Some people abroad regard the ratio of P-ⅲ-P/PZ-peptidase as a dynamic non-invasive index of liver fibrosis. The results of this study showed that the ratio of serum P-ⅲ-P/P-Z peptidase increased with the aggravation of liver fibrosis. The results showed that P-ⅲ-P/P-Z peptidase ratio was a useful index reflecting collagen metabolism and liver fibrosis degree.

(2) Detection of collagen, procollagen peptide and collagen metabolites:

① Type III procollagen (PC-III) and type III procollagen terminal peptide (P-III-P): When PC-III is secreted from cells into blood, the amino (N) terminal peptide and carboxyl (C) terminal peptide are cut off by endonuclease and free in blood, which increases with the activity of collagen synthesis. The diameter of P-ⅲ-P is 60nm, and these peptide terminals can adjust the diameter of collagen fibers. In 1985, Galambos established RIA method to detect PC-ⅲ in serum of 50 patients with liver diseases. The results showed that the value of PC-ⅲ was related to the activity of liver fibers. In 1990, Li Weidao and others established the RIA method of PC-ⅲ extracted from human fetal skin, and the normal limit was 120 μ g/L.. In 1979, Rohde first extracted the amino terminal polypeptide of type ⅲ procollagen from fetal calfskin, and established radioimmunoassay to report the significance of determination of P-ⅲ-P in the diagnosis of liver diseases. Up to now, there are many reports about P-ⅲ-P at home and abroad. It is considered that P-ⅲ-P is still a good index to reflect the activity degree of liver fibrosis, and to judge the course of anti-fibrosis drugs and the prognosis of chronic liver diseases. However, there are still some problems to be discussed. First of all, it has no organ specificity, so when diagnosing liver diseases, it is necessary to exclude the increase of P-ⅲ-P caused by other diseases. Secondly, the serum P-ⅲ-P content overlaps greatly in various liver diseases, so it is difficult to determine the type of liver diseases.

② Determination of type IV collagen and its decomposition fragments (7S fragment and NC1 fragment): Type IV collagen is distributed under the endothelial cells of hepatic sinusoids, which is the main component of basement membrane and has high affinity with LN. Excessive deposition makes hepatic sinusoids capillary, changes hepatic sinusoidal tissue structure and hepatic blood flow, and limits liver nutrition, thus aggravating liver diseases. In the early stage of liver fibrosis, collagen ⅳ was deposited, and the contents of P-ⅲ-P, 7S and NC-1 in blood increased, especially 7S and CN-1. Some people think that serum 7S and NC1 contents are sensitive indexes reflecting collagen synthesis. It has also been reported that the test kit (Japan) for detecting serum ⅳ collagen by enzyme-linked method has been supplied to the market.

(3) Related indexes of matrix composition change:

① Laminin (LN): LN, also known as laminin and polar laminin, is a non-collagen structural glycoprotein in matrix, which is a unique component of basement membrane. It is decomposed into seven peptide fragments by digestive enzymes, and most of the antigenic determinants exist in fragment I (LNP1), with a molecular weight of about 250KD. At present, the antigen-antibody system of LNPI is used to establish RIA detection methods, which can not only obtain enough antigens, but also do not affect the specificity and sensitivity of detection, which makes it possible to popularize the detection methods of serum LN level. Misoki et al. measured serum LN levels in normal people and patients with different liver diseases by RIA. The results showed that normal people, slow migrating liver, slow living liver and cirrhosis were 1340 ng/L, 1600 ng/L, 2060 ng/L and 2200ng/L respectively. At present, most scholars believe that serum LN can be used as one of the indexes to diagnose early liver fibrosis, but it is not specific. Serum LN can also increase in patients with malignant tumors and pancreatic diseases, so LN still has some limitations.

② Fibronectin (FN) and its receptor (FNR): In the liver, FN mainly exists in the sinusoidal wall and coexists with type ⅰ, ⅲ and ⅳ collagen, which acts as a scaffold and is also a component of basement membrane. There are many reports on the determination of serum FN in China. Using single dilation method, hemagglutination method and rocket electrophoresis method, the serum FN of patients with acute and chronic hepatitis is increased, and the FN of early cirrhosis is also obviously increased; However, it decreased after decompensation. Most scholars believe that it is not a good index for early diagnosis of liver fibrosis. It has been reported abroad that 75 cases of serum β-subunit FNR confirmed by liver biopsy were detected by enzyme-linked assay. It is considered that serum FNR level is closely related to the degree of liver fibrosis, but there are no more reports to confirm it.

③ Hyaluronic acid (HA): HA is the most single glycosaminoglycan, which is synthesized by interstitial cells, passes through lymph nodes, and finally enters blood. Most HA is absorbed by hepatic endothelial cells, degraded into acetic acid and lactic acid by interstitial cells, and excreted through kidney. It has been reported that in 117 patients with liver diseases, the blood HA of 47 patients with liver cirrhosis diagnosed by pathology is higher than 100 μ g/L, and most of them are higher than 200 μ g/L; Only 26 of 70 non-cirrhotic patients were higher than 100 μ g/L; Of 207 normal controls, only 5 were higher than 100 μ g/L.. There have been many reports on the application of HA in liver diseases at home and abroad, and the results can be summarized as follows: acute hepatitis, slow migrating liver, slow living liver and liver cirrhosis all have different degrees of elevation of serum HA, which is related to the degree of liver damage and liver fibrosis activity. However, it should be noted that serum HA increases in patients with malignant tumor, rheumatoid arthritis and respiratory distress syndrome.

2. Participate in regulating liver fibersCytokine detection of dimension formation

During the repair of acute hepatitis, TGF-β 1 may initiate the synthesis of collagen and other stroma. Some people think that TGF-β 1 may be a factor linking inflammatory process with liver fibrosis. There have been many clinical reports about serum TNF-α. Some people think that the activity degree of liver fibrosis in schistosomiasis is related to serum TNF-α and HA through animal experiments and clinical studies. If the level of serum cytokines is predicted as an auxiliary index for the diagnosis of active liver fibrosis on the basis of extensive research, it is worth further study.

Imaging examination

1. Ultrasonic examination

There are abnormal changes of liver echo in liver fibrosis.

2. CT

CT showed thickening of liver capsule, irregular or nodular contour of liver surface, uneven enhancement of echo of liver parenchyma or elevation of CT value, change of proportion of each lobe, increase of spleen thickness, widening of portal vein and splenic vein. Color Doppler can measure the blood flow of hepatic artery and portal vein and functional portal-systemic shunt. But on the whole, imaging examination is not sensitive enough to diagnose liver fibrosis.

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