乙肝病毒感染模式与病毒复制及丙氨酸氨基转移酶的关系  

Viral replication and ALT level in hepatitis B patients with different patterns of HBV infection

作　　者：凌利芬[1] 吴正林[1] 李振华[1] 何涛君[1] 陆学东[1] 

机构地区：[1]广东医学院附属深圳第四(福田)人民医院检验科,广东深圳518033

出　　处：《中国热带医学》2016年第7期709-712,共4页China Tropical Medicine

基　　金：深圳市福田区卫生公益性科研项目(No.FTWS2014006)

摘　　要：目的探讨乙型肝炎病毒(HBV)不同感染模式病毒复制情况以及各模式丙氨酸氨基转移酶(Aminotransferase,ALT)含量差异分析。方法采用酶联免疫吸附试验(ELISA)、荧光定量PCR以及自动化生化分析仪速率法对1 021例乙型肝炎病毒感染者进行HBV血清标志物:HBV表面抗原(HBs Ag)、抗HBV表面抗原-抗体(HBs Ab)、HBV e抗原(HBe Ag)、抗HBV e抗原-抗体(HBe Ab)、HBV核心抗体(HBc Ab),HBV-DNA含量以及ALT检测,并对常见三种模式HBV-DNA含量以及ALT进行差异分析,同时依据血清学免疫指标HBe Ag以及病毒复制情况将资料分为四组:HBe Ag(+)HBV-DNA(+)、HBe Ag(+)HBV-DNA(-)、HBe Ag(-)HBV-DNA(+)、HBe Ag(-)HBV-DNA(-),并对该四组资料肝功能差异进行分析。结果此研究发现HBV感染有7种模式,乙型肝炎患者血清中HBV-DNA阳性百分比为45.25%,ALT>40 U/L的人群百分比为20.27%,ALT>120 U/L人群百分比为3.13%;HBe Ag(+)组与HBe Ag(-)两组HBV-DNA阳性百分比差异有统计学意义,两组丙氨酸氨基转移酶异常率差异有统计学意义(P<0.05)。HBe Ag(-)HBV-DNA(-)组ALT>40 U/L的人群百分比以及ALT含量均低于其他三组,差异有统计学意义(P<0.05)。结论HBV血清标志物与HBV-DNA复制情况存在相关性,且与ALT水平密切相关,HBV血清标志物与HBV-DNA能准确地判断HBV复制情况以及其传染性,ALT水平能较好地判断感染人群肝功能情况,三者相结合能给临床的诊断以及疗效观察提供可靠的依据。Objective To investigate the viral replication among the hepatic B virus （HBV） patients with different infection patterns, and analyze the differences of alanine transaminase （ALT） level in them. Methods Serum samples of 1 021 HBV carriers admitted in the hospital from May 2014 to March 2015 were collected, and then enzyme-linked immunosorbent assay （ELISA） was used to detect the serum markers of hepatitis B virus （including HBsAg, HBsAb, HBeAg, HBeAb and HBcAb）. The HBV-DNA levels were qualitatively detected by real-time polymerase chain reaction （PCR）, and the ALT levels were determined with a fully-automatic biochemical analyzer. The differences of HBV-DNA and ALT levels were analyzed among the 3 common infection patterns. At the same time, the differences of liver function were analyzed in 4 groups, that is, HBeAg（＋） HBV-DNA （＋）, HBeAg（＋） HBV-DNA （-）, HBeAg（-） HBV-DNA （＋）, and HBeAg（-） HBV-DNA （-） groups which were assigned according to the serological HBeAg immune markers and viral replication. Results There were 7 infection patterns in the subjected hepatitis B patients, with 45.25% of them positive to HBV-DNA, 20.27% with ALT level〉40 U/L, and 3.13% with ALT level〉120 U/L. Significant differences were found in the positive rates of HBV-DNA and abnormal rates of ALT level between the HBeAg （＋） group and HBeAg （-） groups （P〈0.05）. The ALT levels and percentage of the patients with ALT〉40 U/L were significantly lower in the HBeAg （-）HBV-DNA （-） group than the other 3 groups （P〈 0.05）. Conclusion There is a correlation between HBV serum markers and HBV-DNA replication,which are also associated with the ALT level. HBV serum markers and HBV-DNA can accurately evaluate the HBV replication and infectivity, and ALT level can evaluate liver function in hepatitis B patients. Therefore, the combination of the 3 indicators can provide reliable evidence for clinical diagnosis and therapeutic assessment.

关 键 词：乙型肝炎病毒 乙型肝炎病毒E抗原 乙型肝炎病毒DNA 丙氨酸氨基转移酶 

分 类 号：R512.62[医药卫生—内科学]