高病毒载量HCV RNA的应用价值探讨

Clinical values of high level HCV RNA in the diagnosis and treatment of hepatitis C patients

目的分析高病毒载量丙型肝炎(丙肝)患者丙型肝炎病毒(HCV)RNA和肝功能指标的关系,探讨其临床应用价值。方法同时检测194例丙肝病毒定量(HCV RNA)≥4.0×105IU/ml高病毒载量丙肝患者的肝功能指标,进行组间比较和分析。结果不同HCV RNA载量患者的肝功能检测结果显示组间天冬氨酸转氨酶(aspartate aminotransferase,AST)、丙氨酸转氨酶(alanine amiotransferase,ALT)、α-L-岩藻糖苷酶(α-L-fucosidase,AFU)、谷氨酸脱氢酶(glutamate dehydrogenase,GLDH)和总胆汁酸(total bile acid,TBA)的异常率差异无统计学意义(P>0.05);高病毒载量丙肝患者的肝功能指标异常率最高的是AST(66.49%),其次为ALT(60.82%);HCV RNA载量与肝功能指标无线性相关(P>0.05);肝功能单项检测ROC曲线下面积(area under curve,AUC)分别为AST(0.867)、ALT(0.844)、GLDH(0.755)、TBA(0.735)和AFU(0.613),五项联合检测的AUC为0.982,五项联合检测的特异度(99.50%)和灵敏度(88.70%)最高;单项检测与五项联合检测均有诊断价值(P<0.05)。结论高HCV RNA载量并不能完全代替肝功能指标作为独立的病情监测手段,应同时联合检测肝功能指标以全面了解患者的病情进展,为治疗提供可靠依据。

Objective To explore the clinical value of high level HCV RNA and its correlation with biomarkers of liver function. Methods A total of 194 hepatitis C patients whose HCV RNA ≥4. 0 × 105 IU/ml were recruited in the study. Serological markers such as AST,ALT,TBA,AFU,GLDH were examined. Results There were no significant differences in AST,ALT,TBA,AFU,GLDH among groups with different HCV RNA levels（P 0. 05）. The highest abnormal rate of liver function was AST（66. 49%） and then ALT（60. 82%）. There were no linear correlations between HCV RNA levels and all biomarkers of liver function（P 0. 05）. The AUC of AST,ALT,GLDH,TBA and AFU were 0. 867,0. 844,0. 755,0. 735 and 0. 613,respectively. The total AUC of biomarkers of liver function was 0. 982 with the highest of specificity（99. 50%） and sensitivity（88. 70%） in all biomarkers of liver function. Conclusions High level of HCV RNA should not be the single indicator for diagnosis and monitoring the efficacy of hepatitis C treatment.