丙型肝炎病毒RNA载量和肝功能联合检测在丙型肝炎诊断中的意义

Significances of hepatitis C virus RNA and liver function indicators in diagnosis of heptitis C

目的探讨超敏丙型肝炎病毒(HS-HCV)RNA载量与肝功能指标联合检测在丙型肝炎诊断中的临床意义。方法选取2016年1月至2017年6月在山东大学附属省立医院确诊为丙型肝炎的患者904例。采用实时荧光定量聚合酶链反应法检测HS-HCV RNA;全自动生化分析仪检测肝功能指标,包括总胆红素、直接胆红素(DBIL)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和α-L-岩藻糖苷酶(AFU)水平。采用受试者工作特征曲线分析肝功能指标对丙型肝炎的诊断价值。结果女性患者的HS-HCV RNA阳性率明显高于男性[53.4%(230/431)比43.3%(205/473)](χ~2=9.076,P<0.05)。HS-HCV RNA载量不同分组间总胆红素、DBIL、AST、ALT和AFU异常率差异均有统计学意义(均P<0.01)。丙型肝炎患者肝功能指标异常率最高的是AST(40.3%)。肝功能指标单项检测曲线下面积最高的是AST(0.765),联合检测的曲线下面积为0.853;AST诊断丙型肝炎的灵敏度最高(74.8%),ALT诊断丙型肝炎的特异度最高(79.7%),联合检测的灵敏度(77.8%)和特异度(78.0%)均高于单项检测。结论 HS-HCV RNA载量反映了病毒复制和病程的变化,与肝功能检测结果明显相关。HS-HCV RNA载量及肝功能单项检测与联合检测对于丙型肝炎均有诊断价值,可以全面了解患者的病情进展与转归,为患者治疗提供可靠的依据。

Objective To explore the clinical significances of hypersensitive hepatitis C virus（HS-HCV） RNA and liver function indicators in diagnosis of heptitis C. Methods Totally 904 patients with hepatitis C were enrolled from January 2016 to June 2017 in Shandong Provincial Hospital Affiliated to Shandong University. HS-HCV RNA was detected by the real-time fluorescent quantitative polymerase chain reaction. Levels of total bilirubin（TBIL）, direct bilirubin（DBIL）, aspartate aminotransferase（AST）, alanine aminotransferase（ALT） and α-L-fucosidase（AFU） were detected by the automatic biochemical analyzer. Values of liver function indicators in diagnosis of heptitis C were analyzed by the receiver operating characteristic（ROC） curve. Results Positive rate of HS-HCV RNA in female patients was significantly higher than that in male patients［53.4%（230/431） vs 43.3%（205/473）］（χ2＝9.076, P＜0.05）. Abnormal rates of TBIL, DBIL, AST, ALT and AFU showed significant differences among groups with different HS-HCV RNA（P＜0.01）. Abnormal rate of AST was the highest in hepatitis C patients（40.3%）. Area under curve of AST in diagnosis of heptitis C was 0.765; area under curve of combined detection of 5 liver function indicators was 0.853. The sensitivity of AST（74.8%） and the specificity of ALT（79.7%） was the highest in diagnosis of heptitis C; combined detection showed higher sensitivity（77.8%） and specificity（78.0%）. Conclusions HS-HCV RNA can reflect virus replication and course of hepatitis C; it is associated the levels of liver function indicators. HS-HCV RNA and liver function indicators have good diagnostic values for hepatitis C.