血清丙型肝炎病毒-RNA含量联合肝功能检测在丙型肝炎患者诊断中的应用价值研究

Study on the application value of combined detection of serum hepatitis C virus-RNA level andliver function indices in diagnosis and treatment of hepatitis C patients

目的 探讨丙型肝炎患者血清丙型肝炎病毒（HCV）-RNA含量与胆碱酯酶（CHE）、前白蛋白（PA）和白蛋白（ALB）的关系,为丙型肝炎患者的早期诊断和治疗效果监测提供参考依据.方法 选取丙型肝炎患者455例,采用实时荧光聚合酶链反应（PCR）分析仪检测血清HCV-RNA含量,全自动生化分析仪检测CHE、ALB和PA.根据患者血清HCV-RNA含量分为六组,HCV-RNA〈103 kU/L组（A组,52例）、103 kU/L≤HCV-RNA〈104 kU/L组（B组,77例）、104 kU/L≤HCV-RNA〈105 kU/L组（C组,81例）、105 kU/L≤HCV-RNA〈106 kU/L组（D组,92例）、106 kU/L≤HCV-RNA〈107 kU/L组（E组,87例）和HCV-RNA≥107 kU/L组（F组,66例）;再根据患者血清CHE水平分为CHE正常组（〉5000 U/L,321例）、CHE轻度异常组（4000~5000 U/L,56例）和CHE异常组（〈4000 U/L,78例）.结果 A组、B组、C组、D组、E组和F组血清CHE、ALB、PA逐渐降低[CHE：（7288±2817）、（6316±2341）、（6103±2596）、（5208±2222）、（4282±2173）和（3905±1378）U/L;ALB：（46.3±9.9）、（44.0±8.4）、（43.1±7.6）、（42.6±7.1）、（41.1±5.4）和（39.3±5.1）g/L;PA：（212.1±67.8）、（179.9±72.8）、（163.4±57.5）、（137.4±60.3）、（120.6±45.0）和（112.5±42.0）mg/L],差异有统计学意义（F=21.08、6.08和27.54,P〈0.01）;CHE正常组、CHE轻度异常组和CHE异常组血清ALB和PA逐渐降低[ALB：（45.4±10.1）、（33.1±4.2）和（31.5±8.8）g/L;PA：（209.3±56.4）、（108.4±44.1）和（81.5±49.6）mg/L],差异有统计学意义（F=70.23和152.57,P〈0.01）.双变量Spearman相关分析结果显示,血清HCV-RNA含量与血清CHE、ALB和PA呈负相关（r=-0.357、-0.326和-0.471,P〈0.05）,血清CHE与血清ALB和PA呈正相关（r=0.726和0.807,P〈0.05）.结论 丙型肝炎患者血清HCV-RNA含量与血清肝功能指标密切相关.血清HCV-RNA含量与肝功能指标PA同时检测对丙型肝炎的早期诊疗具有一定价值.

Objective To explore the correlation between serum hepatitis C virus （HCV）-RNA level with cholinesterase （CHE）, albumin （ALB） and prealbumin （PA） in patients with hepatitis C, and provide the references for the early diagnosis and the prognosis monitoring of hepatitis C. Methods Four hundred and fifty-five patients with hepatitis C were selected. The serum level of HCV-RNA was determined by quantitative real-time polymerase chain reaction （real-time PCR）, and serum levels of CHE, ALB and PA were detected using the automatic biochemistry analyzer. The patients were divided into 6 group according to the result of HCV-RNA level：HCV-RNA〈103 kU/L group （group A, 52 cases）, 103 kU/L≤HCV-RNA〈104 kU/L group （group B, 77 cases）, 104 kU/L≤HCV-RNA〈105 kU/L group （group C, 81 cases）, 105 kU/L≤HCV-RNA〈106 kU/L group （group D, 92 cases）, 106 kU/L≤HCV-RNA〈107 kU/L group （group E, 87 cases） and HCV-RNA≥107 kU/L group （group F, 66 cases）. Moreover, the patients were divided into 3 groups according to the result of serum CHE： CHE normal group （〉 5000 U/L, 321 cases）, CHE mild abnormal group （4000- 5000 U/L, 56 cases） and CHE abnormal group （〈4000 U/L, 78 cases）. Results With the rising level of serum HCV-RNA from group A to group F, the serum levels of CHE, ALB and PA were all gradually decreased in hepatitis C patients, CHE： （7288 ± 2817）, （6316 ± 2341）, （6103 ± 2596）, （5208 ± 2222）, （4282 ± 2173） and （3905 ± 1378） U/L; ALB： （46.3 ± 9.9）, （44.0 ± 8.4）, （43.1 ± 7.6）, （42.6 ± 7.1）, （41.1 ± 5.4） and （39.3 ±5.1） g/L;PA：（212.1 ± 67.8）, （179.9 ± 72.8）, （163.4 ± 57.5）, （137.4 ± 60.3）, （120.6 ± 45.0） and （112.5 ± 42.0） mg/L, and there were statistical differences （F=21.08, 6.08 and 27.54;P〈0.01）. With the decreasing level of serum CHE, the serum levels of ALB and PA were all gradually decreased, ALB：（45.4 ± 10.1）, （33.1 ± 4.2） and （31.5 ± 8.8） g/L;PA：（209.3 ± 56.4）, （108.4 ± 44.1） and （81.5 ± 49.6） mg/L, and there were statistical differences （F = 70.23 and 152.57, P〈0.01）. The bivariate Spearman correlation analysis result showed that the serum HCV-RNA level was negatively correlated with serum CHE, ALB and PA （r =-0.357, -0.326 and-0.471; P〈0.05）, and the serum CHE was positively correlated with serum ALB and PA （r=0.726 and 0.807, P〈0.05）. Conclusions The serum HCV-RNA level is closely related to liver function indices. Performing simultaneous detection of serum HCV-RNA level and serum PA is helpful in the early diagnosis and treatment of Hepatitis C.