慢性乙型肝炎患者两对半指标变化监测分析

Dynamic changes of serum markers in patients with chronic hepatitis B

目的 探讨慢性乙型肝炎患者两对半指标变化的监测价值.方法 2012年9月到2014年8月期间,选择在本院传染科进行诊治的110例慢性乙型肝炎患者作为研究对象,都进行了两对半指标检测、HBV-DNA定量检测和免疫指标检测,并且进行了相关性分析.结果 在110例患者中,出现大三阳（HBsAg、HBeAg及HBcAb阳性）32例,占比29.1％;小三阳（HBsAg、HBeAb及HBcAb阳性）38例,占比34.5％,各型模式对比具有差异性（P＜0.05）.HBV-DNA定量平均值为（3.26±0.45）×10^6/ml,其中大三阳与小三阳模式的HBV-DNA定量值明显高于其他模式（P＜0.05）.血清IFNγ和IL-4平均值为（18.23±7.14） pg/ml和（25.54±10.44） pg/ml,其中大三阳与小三阳模式的IFNγ和IL-4值明显高于其他模式（P＜0.05）.Spersonman相关性分析显示大三阳与小三阳比率与HBV-DNA定量、血清IFNγ和IL-4表达呈现明显正向相关性（P＜0.05）.治疗后HBV-DNA转阴89例,转阴率为80.9％.结论 慢性乙型肝炎患者两对半指标监测能有效反映机体的HBV-DNA定量情况与免疫状况,从而判断患者病情变化,指导进行临床治疗.

Objective To investigate the clinical values of dynamic changes of serum markers in patients with chronic hepatitis B.Methods One hundred and tenpatients with chronic hepatitis B were selected as research subjects from the infectious department of our hospital from Sep 2012 to Aug 2014.All samples were tested for HBV serum markers,HBV-DNA as well as quantitative analysis of immune parameters,and the results were analyzed by correlation analysis.Results The detection rate for HBsAg,HBeAg and HBcAb positive patients was 29.1% and for HBsAg,HBeAb and HBcAb positive patients was 34.5%.There was no significant difference between both types of patients （P 〈 0.05）.The average level of HBV-DNA was （3.26 ± 0.45） ×10^6 copy/ml.HBV-DNA titers both in HBsAg,HBeAg and HBcAb positive patients and in HBsAg,HBeAb and HBcAb positive patients were significantly higher than other patients （P 〈0.05）.The average levels serum IFNγand IL-4 were （18.23 ± 7.14） pg/ml and （25.54 ± 10.44） pg/ml,respectively.The average levels of serum IFNγ and IL-4 of both the HBsAg,HBeAg and HBcAb positive patients and HBsAg,HBeAb and HBcAb positive patients were significantly higher than other patients （P 〈 0.05）.Spersonman correlation analysis showed that the ratio between HBsAg,HBeAg and HBcAb positive patients and HBsAg,HBeAb and HBcAb positive patients was positively related to the quantitative serum IFNγIL-4 expression and HBV-DNA （P 〈 0.05）.After treatment,negative conversion of HBV-DNA occurred in 89 patients with a negative conversion rate of 80.9%.Conclusions Serum markers could be used as effective indicators to reflect HBV-DNA titers and the immune status duringchronic hepatitis B patients monitoring,and to guide treatment.