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目的通过检测乙型肝炎(乙肝)患者的血清标志物、ALT及乙肝病毒(HBV)-DNA,分析三项指标联合检测在乙肝患者诊断、疗效观察和预后判断中的应用价值。方法对1 235例乙型肝炎患者的HBV血清标志物(HBsAg、HBsAb、HBeAg、HBeAb、HBcAb)采用ELISA定性试验,ALT采用速率法检测,HBV-DNA载量采用实时荧光定量聚合酶链反应(PCR)。结果 1 235例乙型肝炎患者血清学标志物阳性血清中,有736例检测出HBV-DNA阳性,阳性率为59.60%。其中模式A组(1、3、5阳性,“大三阳”)492例,血清中HBV-DNA阳性484例,阳性率98.37%;模式B组(1、3阳性)6例,血清中HBV-DNA阳性6例,阳性率100%;模式C组(1、4、5阳性,“小三阳”)564例,HBV-DNA阳性198例,阳性率35.11%;模式D组(1、5阳性)114例,HBV-DNA阳性41例,阳性率35.96%;模式F组(5阳性)17例,HBV-DNA阳性6例,阳性率35.29%;模式H组(全阴性)5例,HBV-DNA阳性1例,阳性率20.00%;其余组别HBV-DNA均阴性。以模式A、B组HBV-DNA阳性率和平均载量为最高,且明显高于其他模式组(P均<0.01)。模式A、B组ALT阳性率和含量的中位值分别高于其他各组(P均<0.01)。在HBV-DNA阳性患者中,HBV-DNA载量与ALT水平呈正相关(r=0.678,P<0.05)。结论 HBV-DNA载量与血清标志物以及ALT水平之间存在着一定的关系,三者反映的是疾病的不同方面,所表达的意义各有侧重;在HBV感染的诊疗过程中联合检测,对判断病情转归、抗病毒疗效等可互相补充,从而为乙肝患者的诊断与治疗提供更有效的参考依据。
Objective To evaluate the value of combined detection of three indexes in the diagnosis, curative effect and prognosis of hepatitis B patients by detecting the serum markers, ALT and HBV DNA of patients with hepatitis B (hepatitis B). Methods The serum HBV markers (HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) in 1 235 hepatitis B patients were tested by ELISA, the ALT was detected by the rate method, and the HBV-DNA load was measured by real-time fluorescence quantitative polymerase chain reaction PCR). Results Serum HBV-DNA was positive in 736 seropositive samples of 1 235 Hepatitis B patients, with a positive rate of 59.60%. Among 492 cases of group A (1,3,5 positive, “Sanyang”), the positive rate of HBV-DNA in serum was 484, the positive rate was 98.37%; in model group B (1,3 positive) HBV-DNA positive in 6 cases, the positive rate of 100%; model C group (1,4,5 positive, “Sanyang”) 564 cases, HBV-DNA positive in 198 cases, the positive rate of 35.11%; model D group (N = 5), 114 in HBV-DNA positive and 41 positive in HBV-DNA, the positive rate was 35.96%; 17 in model group F (5 positive) and 6 in HBV-DNA positive group Cases, HBV-DNA positive in 1 case, the positive rate of 20.00%; the remaining group were negative for HBV-DNA. In group A and group B, the positive rate and average load of HBV-DNA were the highest, which were significantly higher than those in other modes (all P <0.01). Mode A, B group ALT positive rate and the median of the content were higher than the other groups (P all <0.01). In HBV-DNA positive patients, HBV DNA load was positively correlated with ALT level (r = 0.678, P <0.05). Conclusion There is a relationship between HBV DNA load and serum markers and ALT levels. The three reflect different aspects of the disease, and their meanings are different. In the course of diagnosis and treatment of HBV infection, To determine the prognosis of the disease, anti-viral efficacy can complement each other, so as to provide a more effective reference for the diagnosis and treatment of hepatitis B patients.