早期诊断急性乙型肝炎的新指标:抗HBc-IgM/HBV DNA定量log值  

A new index for early diagnosis of acute hepatitis B:quantitative log value of anti-HBc-IgM/DNA

作　　者：赵伟[1] 陈艳清 季媛媛[2] 程琳[1] 周海东[1] 郭长峰[1] ZhAO Wei;CHen Yan-qing;JI Yuan-yuan;CHENG Lin-;ZHOU Hai-dong;GUO Chang-feng(Tenth People’s Hospital of TongJi University,Shanghai 200072,China;Shanghai public health clinical center,Shanghai 201508,China)

机构地区：[1]同济大学附属第十人民医院,上海200072 [2]上海市(复旦大学附属)公共卫生临床中心

出　　处：《肝脏》2022年第6期655-657,共3页Chinese Hepatology

基　　金：上海市公共卫生临床中心院内课题KY-GW-2019-59。

摘　　要：目的探讨早期诊断急性乙型肝炎的指标。方法收集132例急性乙型肝炎和277例慢性乙型肝炎病例。通过统计分析发现两组存在统计学差异的指标,计算ROC曲线下面积(AUC)诊断急性乙型肝炎的敏感度和特异性。结果入院48 h内的抗HBc-IgM/DNA定量log值,急性乙型肝炎组为5.18(0.03,13.65),较慢性乙型肝炎组的0.04(0.01,3.48)明显升高,差异有统计学意义(P=0.000)。抗HBc-IgM/DNA定量log值诊断急性乙型肝炎的敏感度95.45%,特异性97.47%,最佳约登指数0.929,AUC为0.991,cutoff值1.025,简化为1时敏感度和特异性不变。抗HBc-IgM/DNA定量log值与传统指标抗HBc-IgM相比,诊断急性乙型肝炎的AUC差异有统计学意义(P=0.001)。结论入院48 h内的抗HBc-IgM/DNA定量log值,可作为早期诊断急性乙型肝炎的一个新指标,≥1考虑急性乙型肝炎。Objective To distinguish acute hepatitis B(AHB)from chronic hepatitis B(CHB),and to diagnose AHB at the earliest time.Methods One hundred and thirty-two cases of AHB and 277 cases of CHB were collected and compared for identifying differential indexes between these two groups.Receiver operating characteristic(ROC)curve analysis was performed to obtain the maximum index in area under the curve(AUC)and calculate the sensitivity and specificity for diagnosing AHB.Results(1)The quantitative value of anti-HBc-IgM/DNA log within 48 hours after admission in AHB group was 5.18(0.03-13.65),which was significantly higher than those of 0.04(0.01-3.48)in CHB group(P=0.000).(2)The sensitivity and specificity of quantitative value of anti-HBc-IgM/DNA log in the diagnosis of AHB is 95.45%and 97.47%.The best Youden index is 0.929,the AUC is 0.991,and the cutoff value was 1.025.When simplified to 1,the sensitivity and specificity remained unchanged.(3)Compared with the traditional index anti-HBc-IgM,the AUC difference of anti-HBc-IgM/DNA log in the diagnosis ofAHB is statistically significant(P=0.001).Conclusion The quantitative log value of anti-HBc-IgM/DNA within 48 hours after admission can serve as a new index for early diagnosis of AHB.AHB can be considered when the log value is more than or equal to 1.

关 键 词：抗HBc-IgM/DNA定量log值 早期诊断 急性乙型肝炎 慢性乙型肝炎 

分 类 号：R51[医药卫生—内科学]