丙型肝炎病原学检测的临床应用效果评价

The analysis of clinical significance of etiological detection of hepatitis C

目的 了解我国丙型肝炎病毒感染的病原学诊断现状 ,探讨合理有效的临床应用模式。方法 用酶联免疫吸附试验 (ELISA)检测抗HCV抗体 ,用荧光定量反转录聚合酶链式反应 (FQRT PCR)技术定量检测HCV RNA ,用速率法检测ALT水平。结果 188份抗HCV IgG阳性标本中 10 3份HCV RNA阳性 (大于 10 3 拷贝·mL-1) ,阳性率 5 4 .7% ;10 7份HCV RNA阳性标本中 ,有 4份抗HCV IgG阴性 (3.7% ) ,二者一致率 6 9.8% ,不一致率 30 .2 % ;HCV RNA载量与ALT水平无明显相关性。结论 用ELISA检测抗HCV IgG筛查丙肝病人会有 3.7%的病毒血症者漏检 ,且有 4 5 .2 %的假阳性 (无传染性 ) ;用抗HCV IgG阳性加ALT升高作为诊断丙型肝炎现症患者价值有待探讨 ;抗HCV IgG的出现与否与HCV RNA载量无关。

Objective To investigate the situation of etiological diagnosis of hepatitis C in our country and discuss rational valid detection model. Methods Anti-HCV-IgG was detected using ELISA, HCV-RNA was detected using FQRT-PCR, the level of ALT was detected by velocity method. Results 103 of 188 anti-HCV-IgG positive samples were HCV-RNA positive (over 10 3 copies/mL), whereas 4 of 107 HCV-RNA positive samples were anti-HCV-IgG negative (3.7%). The coincidence rate of such methods was 69.8% and the diverse rate was 30.2%. Therefore, there was no remarkable correlation between HCV-RNA concentration and ALT level. Conclusion Screening hepatitis C by ELISA for anti-HCV-IgG may lead to 3.7% viremic patients who fail to be diagnosed and 45.2% false-positive cases (the patients without infection). The value of using anti-HCV-IgG positive with the increase of ALT as standard of hepatitis C diagnosis needs to be further studied, and the presence of anti-HCV-IgG has nothing to do with the concentration of HCV-RNA.