血清标志物在慢性HBV感染自然史中的诊断价值研究  

Study on the Diagnostic Value of Serum Markers in the Natural History of Chronic HBV Infection

作　　者：余文君 余婷婷 李丽华 王红英 普冬 Yu Wenjun;Yu Tingting;Li Lihua;Wang Hongying;Pu Dong(College of Public Health,Dali University,Dali,Yunnan 671000,China;Department of Laboratory,Kunming Third People's Hospital,Kunming 650041,China)

机构地区：[1]大理大学公共卫生学院,云南大理671000 [2]昆明市第三人民医院检验科,昆明650041

出　　处：《大理大学学报》2025年第2期67-74,共8页Journal of Dali University

基　　金：云南省教育厅科学研究基金项目(2023J0917);昆明市卫生健康委员会卫生科研课题项目(2021-11-01-0010);昆明市卫生科技人才培养项目(2023-SW(后备)-08)。

摘　　要：目的:评估血清标志物在慢性HBV感染自然史分期中的诊断价值。方法:回顾性分析2020年11月至2023年12月昆明市第三人民医院收集的172例未经抗病毒治疗的慢性HBV感染患者的临床资料,根据慢性HBV感染的自然史将患者分为4组,分别为EPI组、EPH组、ENI组和ENH组。比较各组患者血清标志物水平变化,并根据ROC曲线评估各指标对EPH期和ENH期的诊断价值。结果:患者的年龄、RDW-SD、HBeAg、HBsAg、HBV DNA、HBV RNA、ALT、AST、GGT、PT、PTA、APRI、FIB-4和GPR在不同组别间差异有统计学意义(P<0.05)。对HBeAg阳性患者和HBeAg阴性患者分别进行单因素分析发现,EPI组和EPH组患者在年龄、Hb、HBeAg、HBsAg、ALT、AST、GGT、AFP、APRI、FIB-4、GPR等指标上差异有统计学意义(P<0.05);ENI组和ENH组患者在HBV DNA、HBV RNA、ALT、AST、GGT、APRI、GPR等指标上差异有统计学意义(P<0.05)。ROC曲线分析显示,多项血清标志物联合诊断预测EPH期和ENH期的诊断效能优于单一指标。结论:多种血清标志物联合诊断具有较高的临床价值,有望为慢性HBV感染分期和抗病毒治疗的选择提供无创诊断支持。Objective:To evaluate the diagnostic value of serum markers in the staging of chronic HBV infection throughout its natural history.Methods:A retrospective analysis was conducted on the clinical data of 172 patients with chronic HBV infection,who had not undergone antiviral treatment,collected from November 2020 to December 2023 at Kunming Third People's Hospital.Based on the natural history of chronic HBV infection,patients were classified into four groups:EPI,EPH,ENI,and ENH.Changes in serum marker levels were compared among these groups,and the diagnostic value of each marker for the EPH and ENH stages was assessed using ROC curve analysis.Results:Significant differences were observed among groups in age,RDW-SD,HBeAg,HBsAg,HBV DNA,HBV RNA,ALT,AST,GGT,PT,PTA,APRI,FIB-4,and GPR levels(P<0.05).Univariate analysis for HBeAg-positive and HBeAg-negative patients revealed significant differences between the EPI and EPH groups in age,Hb,HBeAg,HBsAg,ALT,AST,GGT,AFP,APRI,FIB-4,and GPR levels(P<0.05).Similarly,significant differences were found between the ENI and ENH groups in HBV DNA,HBV RNA,ALT,AST,GGT,APRI,and GPR levels(P<0.05).ROC curve analysis indicated that the combined diagnostic prediction using multiple serum markers had a higher diagnostic efficiency for the EPH and ENH stages compared to individual markers.Conclusion:The combined diagnosis of multiple serum markers has high clinical value and is expected to provide noninvasive diagnostic support for the staging of chronic HBV infection and the selection of antiviral therapy.

关 键 词：血清标志物 乙型肝炎病毒 感染 自然史 诊断价值 

分 类 号：R512.6[医药卫生—内科学]