慢性乙型肝炎治疗的ALT水平最佳临界值的初步探讨

Preliminary Study of the Cut-off of ALT level in Treating Chronic Hepatitis B

目的 探讨 ALT在正常参考范围内的慢性乙型肝炎患者（ CHB）治疗的A LT最佳临界值,为临床治疗提供依据. 方法 选择本院2012年7月至2012年12月 HBV-M 均阴性且ALT在正常参考范围内门诊体检者4 6例,同时选取肝功能指标 在正常参考范围内的门诊和住院CHB患者9 5例,共141例,其中门诊体检者与HBV-DNA病毒载量〈104 IU/mL-93例为对照 组, HBV-DNA病毒载量〉104 IU/mL-48例为治疗组,用生化仪测定丙氨酸氨基转移酶（ ALT）水平,同时用PCR检测其 HBV- DN八病毒载量,以 HBV-DNA病毒载量〉104 IU/mL-作为CHB治疗的标准,用 ROC曲线确定慢性乙型肝炎治疗的ALT最佳 临界值.结果治疗组 ALT高于对照组,差异均有统计学意义（17=1 345.0,P = 0.000）,ALT作为CHB治疗的指标,其1？0（：曲 线下面积为0. 699, 95%可信区间是（0. 611,0. 787）,最佳临界值为21. 5 U/L.结论 ALT可作为CHB患者抗病毒治疗的一个 判断指标,其最佳临界值是21. 5 U/L,低于正常参考范围的上限.

Objective To investigate the Cut-off of serum level of ALT in treating Chronic Hepatitis B（CHB） with normal ALT level,and to provide the reference for clinical treatment. Methods 46 healthy people and 95 CHB patients with normal ALT level admitted to our hospital from July 2012 to December 2012 were selected, and were divided into two groups, the control group：93 cases （Including 47 cases with HBV-DNA〈C104 IU/mL- and 46 cases with HBV-M negative） and the treatment group： 48 cases with HBV-DNA^104 IU/mL- , their ALT level were detected by automatic biochemical analyzer, HBV-DNA quantification was determined by Real-Time Fluorescent polymerase chain reaction. Take HBV-DNA^ 104 IU/mL- as treatment standard of CHB with normal ALT level,the Cut-off of ALT level of treating CHB was determined by receiver operating characteristic curve （ROC）. Results The ALT levels of the treatment group were higher than those of the control group？ the differences were statisti-cal significance（（7= 1 345. 0 ,P = 0. 000）. the area under ROC curve was 0. 699 in treating CHB, its 95 % confidence interval were （0. 611,0. 787）U/L,The optimal operating point was 21. 5 U/L. Conclusion ALT could be used as an indicator of antiviral thera-py of CHB with normal ALT level, the optimal operating point was 21. 5 U/L. it were below the upper limit of the normal refer-ence range.