丙型肝炎病毒RNA与核心抗原的相关性及其临床意义

Correlation and the clinical significance of hepatitis C virus RNA and hepatitis C core antigen

目的探讨丙型肝炎患者丙型肝炎病毒(HCV)RNA与HCV核心抗原(HCV cAg)的相关性及其临床意义。方法收集南京中医药大学附属八一医院全军肝病中心就诊的652例丙型肝炎患者血清,分别检测其HCV RNA和HCV cAg,分析二者间以及与丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、直接胆红素(DBil)以及γ-谷氨酰转移酶(GGT)各项生化指标的相关性。结果丙型肝炎患者HCV RNA和HCV cAg阳性率分别为30.2%和39.4%,HCV cAg阳性和阴性患者HCV RNA阳性率差异有统计学意义(χ^2=370.907、P<0.001),HCV RNA与HCV cAg的阳性符合率(即HCV RNA阳性患者中HCV cAg阳性的比率)为95.4%,阴性符合率为84.8%,总符合率(即HCV RNA与HCV cAg同时阳性或同时阴性的患者占比)为88.0%。若以HCV RNA水平为金标准作ROC曲线,HCV cAg的曲线下面积(AUC)为0.968,95%置信区间(CI)为0.948~0.988。HCV RNA与HCVcAg检测值显著相关(r=0.629、P<0.001)。肝功能正常和异常丙型肝炎患者HCV RNA和HCV cAg阳性率差异均有统计学意义(χ^2=140.435、89.507,P<0.001)。HCV RNA和HCV cAg阳性时,ALT、AST、TBil、DBil和GGT与HCV RNA和HCV cAg检测值均不相关。77例患者在接受干扰素加利巴韦林抗病毒治疗前HCV RNA与HCV cAg均为阳性,抗病毒治疗过程中HCV RNA与HCV cAg阴转时机不完全同步,大多数患者[88.7%(68/77)]治疗过程中HCV RNA阴转早于HCV cAg,少数患者[11.3%(9/77)]HCV cAg阴转早于HCV RNA。结论HCV RNA与HCV核心抗原检测对丙型肝炎的诊断和疗效判定具有重要价值;HCV cAg检测方法简单、快速、成本较低,在经济条件相对不发达的国家和地区更有应用价值。

Objective To investigate the correlation between hepatitis C virus RNA and hepatitis C core antigen(HCV cAg)and to evaluate the clinical significance.Methods Serum was collected from 652 patients with hepatitis C.HCV RNA and HCV cAg were quantitatively detected to evaluate the correlation and their correlations with the liver functions of the patients,such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),direct bilirubin(DBil)and gammaglutamyltransferase(GGT).Results The positive rates of HCV RNA and HCV cAg of patients with hepatitis C were 30.2%and 39.4%,respectively,with significant correlation(χ^2=370.907,P<0.001).The positive coincidence rate of HCV RNA and HCV cAg(the ratio of HCV cAg positive among patients with HCV RNA positive)was 95.4%,the negative coincidence rate was 84.8%,the total coincidence rate(the proportion of patients with HCV RNA and HCV cAg positive or negative at the same time)was 88.0%.Taken the results of HCV RNA as the golden standard,the ROC curve showed that the area under the curve(AUC)of HCV cAg was 0.968,95%confidence interval(CI)was 0.948-0.988.HCV RNA load was significantly positively related to HCV cAg content(r=0.629,P<0.001).The positive rates of HCV RNA and HCV cAg in patients with normal and abnormal liver function were both with significant differences(χ^2=140.435,89.507;both P<0.001).When HCV RNA and HCV cAg were positive,ALT,AST,TBil,DBil and GGT were not related with the results of HCV RNA and HCV cAg.There were 77 patients with HCV RNA and HCV cAg positive before receiving antiviral therapy.The time points of HCV RNA and HCV cAg negative conversion were not fully synchronized.The time point of HCV RNA negative conversion was earlier than that of HCV cAg negative conversion in most patients[88.7%(68/77)].For the other patients,the time point of HCV cAg negative conversion was earlier than that of HCV RNA negative conversion[11.3%(9/77)].Conclusions HCV RNA and HCV cAg detection have great valuable in the diagnosis and curative effect determination of hepatitis C;HCV cAg detection is simple,rapid and cheap,which has more application value in relatively undeveloped countries and regions.