HBV感染者血清AST/ALT比值及HBV血清标志物联合检测的辅助诊断价值研究

Clinical Significance of Combined Detection of AST/ALT Ratio and HBV Serological Markers in HBV Infected Patients

为检测HBV感染者在疾病不同阶段血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、AST/ALT比值及HBV血清标志物水平,探讨它们之间的相互关系,采用速率法、ELISA法分别检测收集的296例HBV感染者和99名健康体检者的血清ALT、AST水平及HBV血清标志物,并计算其对应的AST/ALT比值。结果显示,慢性乙型肝炎(CHB)组的HBeAg阳性率高于乙型肝炎肝硬化(LC)组和原发性肝癌(HCC)组;HCC组的抗-HBe阳性率高于CHB组和LC组;CHB组、LC组、HCC组的ALT、AST水平均高于对照组;CHB组的AST/ALT比值小于对照组,LC组的AST/ALT比值和HCC组的AST/ALT比值均高于对照组和CHB组(P<0.05);三疾病组中HBeAg阳性患者的AST、AST/ALT比值与抗-HBe阳性患者的AST、AST/比值ALT没有显著性差异(P>0.05),ROC曲线下面积CHB组以AST/ALT比值为最大,为A=0.71;LC组以AST为最大,A=0.664;HCC组以AST为最大,A=0.675。患者在HBV感染后不同疾病阶段,AST水平、AST/ALT比值发生规律性变化,HBeAg阳性率逐渐降低,抗-HBe阳性率相应升高,提示肝细胞损伤与体免疫紊乱有关,AST/ALT比值可为临床中HBV相关疾病有辅助诊断价值。

To detect the serum level of ALT,AST,AST/ ALT ratio and HBeAg in different stages of HBV related diseases,and to explore the relationship between them.The serum levels of ALT,AST and HBeAg in 296 HBV infected patients and 99 healthy controls were measured by using rate,and ELISA methods.The results showed that the HBeAg positive rate in chronic hepatitis B group（CHB） was higher than that of in liver cirrhosis（LC） and primary hepatic carcinoma（HCC） group.The anti-HBe positive rate in HCC group was higher than that of in LC and CHB group.The serum levels of ALT and AST in CHB,LC and HCC group were higher than that in control group.The AST/ALT ratio in CHB group was lower than that in control group,the AST/ALT ratio in LC and HCC group was higher than that in CHB and control group（P0.05）.There was no significant difference between HBeAg-positive and Anti-HBe-positive patients on the serum levels of AST and AST/ALT ratio（P0.05）.The area under the ROC curve of AST/ALT ratio in CHB group was 0.71,it was higher than that of ALT and AST.In LC group,the area under the ROC curve of AST was 0.664,it was higher than that of ALT and AST/ALT.In HCC group,area under the ROC curve of AST was 0.675,it was the highest.The serum level of AST and AST/ALT ratio were changed as the diseases developing after HBV infection.The HbeAg positive rate was gradually decreased,whereas anti-HBe positive rate was increased.It indicated that the hepatic injury was related with disturbances of body＇s immune system.The AST/ALT ratio could improve the clinical diagnosis of HBV related diseases.