血液淋巴细胞计数、HBV-DNA载量、血清总胆固醇对重型肝炎诊断及预后判断的价值

Diagnostic and Prognostic Value of Blood Lymphocyte Count, HBV-DNA Load, and Serum Total Cholesterol in Severe Hepatitis

目的 探讨血液淋巴细胞计数（BLC）、HBV—DNA载量、血清总胆醇（STC）在预示重型肝炎趋势，诊断早期重型肝炎及判断预后中的价值。方法 选择初诊慢性乙型肝炎（中度）84例，按最终演变情况，分为慢性乙肝（重度）组和重型肝炎组，观察两组BLC、HBV—DNA载量和STC的变化情况，并对重肝患者持续追踪检测STC。结果 与重度组比较，重型组的BLC和STC的异常率较高（P〈0．005和P〈0．05），而BLC和STC的均值较低（P〈0．0005和P〈0．05）。重度组的HBV—DNA载量始终较高，在5．6×10^5～3．1×10^5 copies／ml，而重型组的HBV-DNA载量，则显著降低，有20例阴性，其余12例在1．1～8．2×10^3 copies／ml。重型肝炎患者存活组与死亡组的STC水平存在非常显著性差异（P〈0．0005）。有10例重肝患者PTA〉40％，其中7例STC〈2．6mmol／L，6例死亡。结论 BLC、HBV—DNA载量和S代有助于预测慢性乙肝（中度）的发展趋势，对早期诊断重型肝炎和判断预后有重要价值。

Objective To investigate the value of blood lymphocyte count （ BLC ）, HBV-DNA load and serum total cholesterol （ STC ） in predicting the trend of severe hepatitis, in diagnosis of early stage of severe hepatitis and prognosis. Methods 84 cases with chronic hepatitis B （CHB） （mederate） , were studied. According to development, 84 cases were divided into two groups： CHB（severe） and severe hepatitis. BLC, HBV-DNA load and STC were observed. STC levels in patients with severe hepatitis were dynamically monitored. Results Compared with CHB （severe） group, the abnormal rates of BLC and STC in severe hepatitis group were higber（P 〈0. 0005,P 〈0. 005）, the levels of BLC and STC were lower（ P 〈 0. 0005, P 〈 0. 005 ）. The HBV-DNA loads in CHB （seere） group remained high at 5.6×10^5～3.1×10^5 copies/m], while the HBV-DNA loads in severe hepatitis group were remarkably lower, 20 cases were negative and 12 cases were at 1.1～8.2×10^3 copies/m]. In pa- tients with severe hepatitis, there was significant difference between survival group and dead group in the STC level（ P 〈 0. 0005 ）. 10 eases with PTA higher than 4.0% were noticed, among them, STC levels of 7 cases were lower than 2.6 retool/L, 6 cases died. Conclusion BLC, HBV- DNA load and STC is valuable in predicting the trend of CHB（mederate） and the diagnosis and prognosis of severe hepatitis in time.