不同血清乙肝病毒DNA水平对乙肝患者肝功能指标及乙肝标志物的影响

Influence of serum hepatitis B virus DNA levels on hepatic function indicators and hepatitis B virus markers

目的探讨乙型病毒性肝炎(乙肝)患者血清中不同乙型肝炎病毒DNA(HBV-DNA)水平对肝功能指标及乙肝标志物的影响。方法选择2018年10月—2021年5月清远市中医院收治的60例乙肝患者作为观察组,另外选择本院60名同期健康体检者作为对照组。检测两组患者血清HBV-DNA和乙肝标志物〔包括天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、α-L-岩藻糖苷酶(AFU)、凝血酶原时间(PT)〕水平。根据病毒DNA载量不同,将观察组患者分为观察1组(38例,<5.0×10^(2)kU/L)、观察2组(11例,5.0×10^(2)~<1.0×10^(4) kU/L)、观察3组(7例,1.0×10^(4)~<1.0×10^(6)kU/L)和观察4组(4例,1.0×10^(6)~1.0×10^(8) kU/L)。比较不同血清学模式乙肝患者的HBV-DNA阳性检出率和平均DNA含量,以及不同HBV-DNA水平乙肝患者的肝功能指标及乙肝标志物检测结果。结果大三阳患者HBV-DNA阳性检出率和平均DNA含量均明显高于其他患者,分别为100.00%和(4.52±0.36)×10^(7) kU/L,组间比较差异有统计学意义。观察组中HBV-DNA的阳性检出率明显高于乙肝病毒e抗原(HBeAg)〔48.33%(29/60)比30.00%(18/60),P<0.05〕。观察组AST、ALT、AFU和PT水平均明显高于对照组〔AST(U/L):61.39±4.73比19.05±3.68,ALT(U/L):45.48±5.04比21.19±4.69,AFU(U/L):35.95±3.99比19.46±4.30,PT(s):15.62±2.54比11.56±0.92,均P<0.05〕;观察组中,随着HBV-DNA水平上升,AST、ALT、AFU、PT水平均逐渐升高,各组间比较差异均有统计学意义。结论随着病毒DNA复制量的增加,乙肝患者各项肝功能指标水平也在不断升高,对HBV-DNA进行定量检测能及时有效地评估患者体内病毒复制情况,同时辅以肝功能指标检测,有助于及早发现患者肝功能损伤,从而为治疗方案的确定提供可靠的依据。

Objective To observe the influence of serum hepatitis B virus DNA(HBV-DNA)levels on the hepatic function indicators and hepatitis B markers.Methods The 60 chronic hepatitis B patients from October 2018 to May 2021 in Qingyuan Hospital of Traditional Chinese Medicine were included in the observation group,and other 60 healthy checkups during the same period were included in the control group.The levels of serum HBV-DNA and hepatitis B markers[including aspartate transaminase(AST),alanine aminotransferase(ALT),α-L-fucosidase(AFU)and prothrombin time(PT)]of two groups were detected.According to DNA loads,the patients in observation group were divided into observation group 1(38 cases,<5.0×10^(2) kU/L),observation group 2(11 cases,5.0×10^(2)-<1.0×10^(4) kU/L),observation group 3(7 cases,1.0×10^(4)-<1.0×10^(6) kU/L)and observation group 4(4 cases,1.0×10^(6)-1.0×10^(8) kU/L).The serum HBV-DNA positive detectable rates and average DNA contents of patients with different serum modes as well as the levels of hepatic function indicators and hepatitis B markers for patients with different HBV-DNA levels were compared.Results The HBV-DNA positive detectable rates and average DNA contents in hepatitis B surface antigen(HBsAg),hepatitis B e antigen(HBeAg)and hepatitis B core antibody(HBcAb)positive patients were 100.00%and(4.52±0.36)×107 kU/L,which were higher than those of other patients,with significant differences.In the observation group,the positive detectable rate of HBV-DNA was significantly higher than that of HBeAg[48.33%(29/60)vs.30.00%(18/60),P<0.05].AST,ALT,AFU and PT levels in the observation group were significantly higher than those in control group[AST(U/L):61.39±4.73 vs.19.05±3.68,ALT(U/L):45.48±5.04 vs.21.19±4.69,AFU(U/L):35.95±3.99 vs.19.46±4.30,PT(s):15.62±2.54 vs.11.56±0.92,all P<0.05].With the increasing of HBV-DNA levels,AST,ALT,AFU and PT levels were gradually increased,with statistically significant differences among different groups.Conclusions With the higher DNA replication loads,the hepatic function indicators are increased;serum HBV-DNA quantitative detection is applicable to evaluate the patients'virus replication conditions.The hepatic function indicators can help make early diagnosis of hepatic injury,providing reliable basis on the treatment schemes.