乙肝五项、病毒前S1抗原、病毒DNA联合检测对乙肝的诊断价值

The Diagnostic Value of Five Items of Hepatitis B,Virus PreS1Ag and Virus DNA in the Diagnosis of Hepatitis B

目的:分析乙肝五项、病毒前S1抗原(PreS1Ag)及病毒DNA(HBV-DNA)联合检测对诊断乙型肝炎的临床价值。方法:随机选取本院2016年3月-2017年10月接诊的301例乙肝患者为研究对象,其中乙肝表面抗原阳性者289例,阴性者12例。采集患者血清,分别用酶联免疫法测定乙肝五项和PreS1Ag水平,用荧光定量PCR法测定HBV-DNA水平,比较分析在乙肝五项不同指标组合下PreS1Ag及HBV-DNA的水平,并分析三者间的关系及其对诊断乙型肝炎的临床价值。结果:在所有患者中PreS1Ag阳性率与HBV-DNA阳性率比较,差异有统计学意义(χ~2=29.491,P<0.05)。(1)(3)(5)阳性组和(1)(4)(5)阳性组的PreS1Ag阳性率与HBV-DNA阳性率比较,差异均有统计学意义(χ~2=14.994、17.577,P<0.05)。在HBsAg阳性患者中,PreS1Ag阳性率和HBV-DNA阳性率均明显高于HBeAg阳性率,差异均有统计学意义(P<0.05)。在HBV-DNA阳性患者中,PreS1Ag阳性率高于HBeAg阳性率(P<0.05);在HBV-DNA阴性患者中,HBeAg阴性率高于PreS1Ag阴性率(P<0.05)。病毒载量在5×102~1×107时,HBeAg阳性率及PreS1Ag阳性率随着病毒载量的增高而增高,但是病毒载量≥108时,HBeAg阳性率及PreS1Ag阳性率均表现为下降。结论:乙肝五项、前S1抗原能够在一定的程度上说明乙肝病毒感染和DNA的复制水平,但是联合测定乙肝五项、前S1抗原和乙肝病毒DNA能够更早更准确的判断乙肝病毒的感染及复制状态,能够更好地为临床诊断和评估治疗效果提供依据。

Objective：To analyze the clinical value of combined detection of Hepatitis B five items,Previral S1 Antigen（PreS1Ag） and virus DNA（HBV-DNA） in hepatitis B.Method：A total of 301 Hepatitis B patients admitted from March 2016 to October 2017 in our hospital were randomly selected,289 cases were HBsAg positive and 12 were negative.Collected the patients＇ serum,respectively,levels of hepatitis B five and PreS1Ag were measured by enzyme-linked immunosorbent assay,HBV-DNA levels were determined by fluorescence quantitative PCR,the levels of HBV-DNA and PreS1Ag of HBV in five different combinations of Hepatitis B were compared and analyzed,and the relationship among them and their clinical value in diagnosing Hepatitis B were analyzed.Result：The positive rate of HBV-DNA was significantly higher than that of PreS1Ag in all patients,the difference was statisti cally significant（χ~2=29.491,P〈0.05）.The positive rates of PreS1Ag and HBV-DNA in（1）（3）（5） positive group and（1）（4）（5） positive group were significantly different,the differences were statistically significant（χ~2=14.994,17.577;P〈0.05）.The positive rates of PreS1Ag and HBV-DNA in HBsAg positive patients were significantly higher than those in HBeAg,the differences were statistically significant（P〈0.05）.In HBV-DNA positive patients,the positive rate of PreS1Ag was higher than that of HBeAg（P〈0.05）;in patients with HBV-DNA negative,HBeAg negative rate was higher than that of PreS1Ag（P〈0.05）.The positive rate of HBeAg and PreS1Ag increased with the increase of viral load when the viral load was 5×10~2-1×107,but the positive rate of HBeAg and PreS1Ag decreased when the viral load was greater than 10~8.Conclusion：Five items of Hepatitis B and PreS1Ag can account for HBV infection and DNA replication to some extent,but combined detection of five items of Hepatitis B,PreS1Ag and HBV-DNA in Hepatitis B can be early and accurate to judge Hepatitis B virus infection and replication status,it can provide the basis for clinical diagnosis and evaluation of the therapeutic effect.