乙型肝炎病毒血清标志物模式及丙氨酸氨基转移酶与乙型肝炎病毒DNA载量关系的研究  

Study on relation between HBV serum markers patterns and ALT with HBV-DNA load

作　　者：黄文进[1] 莫宗平 尹小燕 

机构地区：[1]安岳县人民医院,四川资阳642350 [2]都江堰市疾病预防控制中心,四川成都611830

出　　处：《现代医药卫生》2017年第19期2953-2955,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨乙型病毒性肝炎(乙肝)患者血清标志物模式及丙氨酸氨基转移酶(ALT)与乙肝病毒(HBV)-DNA载量的关系。方法采集2015年11月至2016年5月四川省安岳县人民医院收治的292例HBV表面抗原(HBsAg)阳性患者静脉血,采用酶联免疫吸附试验进行乙肝两对半检查即乙肝标志物5项(HBV-M)检测,采用实时荧光定量聚合酶链反应检测HBV-DNA载量,采用速率法检测血清ALT。比较HBV-M模式及ALT与HBV-DNA载量的关系。结果 292例HBsAg阳性患者中大三阳[HBsAg、HBV e抗原(HBeAg)、抗HBV核心抗体(HBcAb)阳性]85例,小三阳[HBsAg、抗HBVe抗体(HBeAb)、HBcAb阳性]165例,1、5阳性(HBsAg、HBcAb阳性)37例,1、2、4、5阳性(HBsAg、HBsAb、HBeAb、HBcAb阳性)5例。大三阳患者HBV-DNA阳性率明显高于其他模式患者,HBV-DNA载量小于1×10~6 U/mL患者中小三阳患者构成比明显高于其他HBV-M模式患者,HBV-DNA载量1×10~6~<1×10~8U/mL、≥1×10~8U/mL患者中大三阳患者构成比明显高于其他HBV-M模式患者,差异均有统计学意义(P<0.05)。HBV-DNA载量小于1×10~6U/mL患者ALT异常率为18.14%(39/215),主要以轻度升高为主,占异常者的87.18%(34/39);HBV-DNA载量1×10~6~<1×10~8U/mL患者中ALT异常率为69.23%(36/52),主要以中、重度升高为主,占异常者的52.78%(19/36);HBV-DNA载量大于或等于1×10~8 U/mL患者中ALT异常率为48.00%(12/25),主要以中、重度升高为主,占异常者的58.33%(7/12)。ALT升高程度与HBV-DNA载量具有一定相关性(r=0.41,χ~2=17.57,P<0.05)。结论乙肝患者HBeAg的存在(大三阳)及ALT的异常程度均与高DNA病毒载量呈一定正相关,只有同时检测HBV-DNA载量、ALT与HBV-M才能为乙肝患者的感染状况、传染性评判及治疗方案的选择提供更有效的指导。Objective To investigate the relationship between serum markers pattern and alanine aminotransferase（ALT）with hepatitis B virus（HBV）-DNA load in the patients with type B viral hepatitis. Methods The venous blood was collected from 292 patients with hepatitis B surface antigen（HBsAg） positive in the Anyue County People′s Hospital from November 2015 to May 2016. The two pairs of semi-hepatitis B,i.e.,5 hepatitis B virus markers（HBV-M）,were detected by adopting the ELISA method,the HBV-DNA load was detected by real time fluorescence quantitative PCR and serum ALT level was detected by adopting the rate method. The relationship between the HBV-M pattern and ALT with HBV DNA loads was investigated. Results Among 292 cases of HBsAg positive,85 cases were big three positive（HBsAg＋,HBeAg＋ and HBcAb＋）,165 cases were small three positive（HBSAg＋,HBeAb＋ and HBcAb＋）,37 cases were 1,5 positive（HBsAg＋,HBcAb＋） and 5 cases were 1,2,4,5 positive（HBsAg＋,HBsAb＋,HBeAb＋ and HBcAb＋）. The positive rate of HBV-DNA in the patients with big three positive was significantly higher than that in other HBV-M patterns; among the patients with HBV-DNA load 1×10^6U/mL,the constituent ratio of the patients with small three positive was significantly higher than that of other HBV-M patterns;among the patients with HBV-DNA load 1×10^6-1×10^8U/mL,≥1×10^8U/mL,the constituent ratio of the patients with big three positive was significantly higher than that of other HBV-M patterns,the difference was statistically significant（P〈0.05）. Among the patients with HBV-DNA load 1×10^6U/mL,the ALT abnormality rate was 18.14%（39/215）,which was mainly mild elevation and accounted for 87.18%（34/39） of abnormality;among the patients with HBV-DNA load 1×10^6-1×10^8U/mL,the ALT abnormality rate was 69.23%（36/52）,which was mainly moderate and severe elevation and accounted for 52.78%（19/36） of abnormality;among the patients with HBV-DNA load ≥1×10^8U/mL,the ALT abnormality rate w

关 键 词：肝炎病毒 乙型 DNA 生物学标记/血液 丙氨酸转氨酶 聚合酶链反应 

分 类 号：R373.21[医药卫生—病原生物学]