HBV感染致肝损伤患者CRP,hsCRP和SAA临床价值的探讨

Clinical Significance of SAA,CRP and hsCRP in HBV Hepatopathy Patients

目的探讨乙型肝炎病毒感染引起肝损伤的患者血清C反应蛋白(CRP)、超敏C反应蛋白(hsCRP)和血清淀粉样蛋白A(SAA)水平对肝脏受损程度的诊断价值。方法纳入武汉大学人民医院感染科乙型肝炎病毒型肝损伤患者127例,并分组,其中临床诊断为急慢性乙型肝炎患者(轻度组)47例,乙肝后肝硬化患者(中度组)35例,慢加急性肝衰竭患者(重度组)45例。同时纳入健康体检者50例。检测上述人群血清CRP,hsCRP和SAA水平,进行统计学分析。结果①病例组与对照组血清CRP和hsCRP水平差异有统计学意义(Mann-Whitney U检验,Z=-2.792,-8.458;P<0.01)。②病例组间血清h8CRP水平差异有统计学意义(Kru8kal-Wallis H检验,x^2=11.625,P<0.01)。③中度组和重度组血清hsCRP水平与轻度组比较,差异有统计学意义(Mann-Whitney U检验,Z=-2.849,-2.902;P<0.01)。④各组间血清SAA水平差异无统计学意义。⑤hsCRP在乙型肝炎病毒致肝损伤患者总体中阳性率为76.29%,高于CRP(11.34%),SAA(26.80%)。结论①乙型肝炎病毒致肝损伤患者血清CRP水平的临床价值优于SAA;②hsCRP水平(免疫比浊法)的临床价值优于CRP(免疫荧光法)。

Objective To explore the diangostic value of serumhigh sensitive C-reaction prtein （hsCRP） serum amyloid a （SAA） and C-reaction protein （CRP） in patients who had HBV hepatopathy. Method 127 subjects with hepatopathy caused by HBV infection and 50 control subjects were incorporated in this research,and 47 cases with HBV hepatitis, 35 ca- ses with HBV cirrhosis and 45 cases with hepatic failure and SAA and CRP hsCRP of every sample was detected. Results ①Levels of CRP and hsCRP in cases were significantly higher than controls （Mann-Whitney U test,Z=-2. 792,-8. 458, P〈0.01）. ②The hsCRP levels in the three different groups of cases were different （Kruskal-Wallis test, x^2=11. 625,P〈 0.01 ）. ③The hsCRP level of group 2 and 3 was significantly higher than group 1 in the hepatic damage groups （Mann-Whit- ney U test,Z=-2. 849, -2. 902,P〈0.01）. ④Bur the level of SAA had no statistically significant in any group.⑤The se- ropositivity of hsCRP in cases group was 76. 29% and it was higher than CRP （11.34%） and SAA（26. 80%）. Conclusion The diangosic value of CRP and hsCRP may better than SAA in the patients who got HBV hepatic damage which maybe caused by detection method as hsCRP is better than CRP.