血清HBV-DNA定量检测与凝血指标对乙肝患者病情诊断的研究

Relationships between coagulation function and the clinical grading of hepatitis B and serum content of HBV-DNA

目的研究乙型肝炎患者凝血功能、临床分型及血清乙肝病毒核糖核酸（HBV-DNA）含量之间的关系。方法收集乙型肝炎患者472例为研究组，健康人群55例作为健康对照组，分别检测凝血功能指标及血清HBV—DNA含量，比较临床分型各组的PT、INR、APTT、TT和FIB的关系以及不同血清HBV—DNA含量组中PT、INR、APTT、TT和FIB的关系。结果男性的FIB（2．31±0．90）明显小于女性FIB（2．67±1．50）（P〈0．05）。慢性乙肝（轻型）组和慢性乙肝（中型）组的PT、APTT、TT均明显低于l陧性乙肝（重型）、肝炎肝硬化（未失代偿）、肝硬化失代偿期组的PT（P〈0．01）。男性与女性对照组的FIB均明显高于急性肝炎组以及慢性乙肝（重型）、肝炎肝硬化（未失代偿）、肝硬化失代偿期组（P〈0．01）。按血清HBV-DNA定量分组患者APTT、TT、FIB值与正常对照组和乙肝患者HBV—DNA含量〈103copy／mL组比较均有显著性差异（P〈0．01）。当103copy／mL〈HBV—DNA〈10scopy／mL时，PT值与正常对照组比较具有显著性差异，血清中HBV—DNA含量分组与PT有正相关性（r=0．159，P=0．000），HBV—DNA含量与FIB呈负相关（r=-0．144，P=O．001）。结论乙肝患者凝血功能异常程度随临床分型的加重而加重，凝血功能的异常随着血清HBV—DNA含量的增加有降低的趋势，PT值的检测是反映乙肝患者凝血功能的灵敏指标。对于HBV—DNA含量在10^5-10^6copy／mL的患者，应该随时监测凝血功能，把握抗病毒治疗的时机。

[ Objective ] To study the relationships between coagulation function and the clinical grading as well as serum content of HBV-DNA in patients with hepatitis B. [Methods] 472 patients of hepatitis B were collected as the case group and 55 healthy people as control group. Parameters of coagulation function （prothrombin time, international normalized ratio, activated partial thromboplastin time, thrombin time, fibrinogen） and the content of HBV-DNA in the serum of the patients with hepatitis B were measured. Then all parameters of coagulation function among different groups divided by the content of HBV-DNA were analyzed. [ Results ] PT, APTF, TT value of mild and moderate the hepatitis B patients showed significant differences compared with controls （P 〈0.05）. There is positively correlated in PT with the amount of HBV-DNA in the serum. When HBV-DNA is 103 copy/mL-105 copy/mL, PT values of hepatitis B patients showed significant differences compared other groups. HBV-DNA content grouping in serum is positive correlation with PT （r =0.159, P =0.000）, HBV-DNA content and FIB is negative correlation（r =- 0.144, P =0.001）. [ Conclusions ] Coagulation abnormalities of Hepatitis B patients increased with chnical classification, coagulation abnormalities decreased with increasing of serum HBV-DNA content. PT value detection is a sensitive index in reflection of coagulation function of patients with hepatitis B. For HBV-DNA content in 10^5-10^6 copy/ mL patients should always be in monitor the coagulation in order to grasp the timing of antiviral treatment.