献血者ALT与HBV、HCV标志物检测结果的关系研究

Study on the relationship between ALT and HBV/HCV markers in blood donors

目的研究无偿献血者丙氨酸氨基转移酶（ALT）与HBV、HCV标志物检测结果的关系,探讨ALT筛查在安全输血中的作用。方法对2016年3月1日—2017年2月28在本中心参加献血的83 618名献血者标本进行ALT、HBs Ag、HBV-DNA、抗-HCV、HCV-RNA检测,并将检测结果进行研究。结果 83 618名献血者标本中共检出2284份ALT异常值标本（ALT〉50 U/L）,不合格率为2.73%;HBs Ag阳性520份,抗-HCV阳性220份;NAT共检出822份,经鉴别试验,其中HBV-DNA阳性516份,HCV-RNA阳性20份。HBs Ag阳性合并ALT异常15份,HBV-DNA阳性合并ALT异常16份;抗-HCV阳性合并ALT异常8份,HCV-RNA阳性合并ALT异常4份;ALT检测值与HBs Ag、HBV-DNA、抗-HCV检测结果的相关性无统计学差异（P〉0.05）;ALT异常组HCV-RNA阳性率与ALT正常组HCV-RNA阳性率有统计学差异（P〈0.01）;绝大部分HBV、HCV标志物阳性献血者中,其ALT检测值处于50 U/L以内。结论 ALT检测效用很小,大量ALT异常值的正常血液被报废处理,影响了无偿献血政策实施的效率和效果。因此不宜将ALT活性检测作为献血者强制筛查项目。

Objective To investigate the relationship between alanine aminotransferase（ ALT） and the detection results of HBV and HCV markers in volunteer blood donors,and to evaluate the role of ALT screening in blood transfusion safety.Methods 83618 samples were collected dating from Mar 1 st,2016 to feb 28 th,2017. Then ALT、HBs Ag,HBV-DNA,anti HCV,HCV-RNA tests were conducted. Results In the ALT test,2 284 out of 83 618 samples were considered abnormal（ ALT〉50 U/L） with an abnormal rate of 2. 73%. 520 samples were HBs Ag positive and 220 were anti-HCV positive.822 samples were processed by NAT,516 of which were HBV-DNA positive and 20 of which were HCV-RNA positive.There were15 HBs Ag-positive and ALT-abnormal samples while 16 samples were HBV-DNA-positive and ALT-abnormal. 8 samples were anti-HCV positive and ALT-abnormal and 4 HCV-RNA-positive and ALT-abnormal samples were detected. No statistical differences（ P〉0. 05） presented between ALT detection value and the results of HBs Ag,HBV-DNA,anti-HCV tests. However,statically significant differences（ P 〈 0. 05） indicated positive probability between ALT abnormal group and positive HCV-RNA and HCV-RNA results. Most of the HBV and HCV positive blood donors possssed a ALT detection value less than 50 U/L. Conclusion The impact of ALT values were less significant than expected,considering the fact that valid blood supply source may also present abnormal ALT values. Therefore,ALT,as a mandatory screening test for blood donors,remains to be further confirmed and evaluated with a larger sample pool and a broader scope.