红细胞外铁分布在HBV感染临床不同阶段的变化及预测再活动期的价值

Change of iron out of erythrocytes in patients with different clinical stages of HBV infection and value in prediction of re-active phase

目的 分析红细胞外铁分布在乙型肝炎病毒(HBV)感染临床不同阶段的变化及预测价值。方法 选择2016年12月-2021年1月在海口市人民医院检验科接受乙肝病毒检测的198例HBV感染患者,分为免疫耐受期、免疫清除期、低复制期、再活动期四组,比较各组乙型肝炎病毒表面抗原(HBsAg)、肝功能指标,检测各组血清铁蛋白(SF)和血清铁(SI)水平,绘制受试者工作特征(ROC)曲线分析血清SF、SI对HBV感染患者再活动期的预测价值。结果 HBV感染患者不同阶段血清SF、血清SI、HBsAg、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)水平比较差异均有统计学意义(P<0.05),以HBV感染免疫清除期为对照,ROC曲线分析显示,血清SF对HBV感染再活动期预测的曲线下面积(AUC)最高,以339.05μg/L为cut-off值,预测HBV感染患者再活动期的敏感度、特异度分别为73.21%、56.34%,并联试验(即血清SF>339.05μg/L或血清SI>33.32μmol/L)敏感度最高(85.71%),串联试验(即血清SF>339.05μg/L及血清SI>33.32μmol/L)特异度最高(92.96%)。结论 HBV感染患者临床不同阶段血清SF、血清SI呈特征性变化趋势,两者可作为HBV感染再活动期的生物标志物。

OBJECTIVE To analyze the change of iron out of erythrocytes in patients with different clinical stages of hepatitis B virus(HBV) infection and observe its predictive value. METHODS Totally 198 patients with HBV infection who received hepatitis virus test in the Haikou People′s Hospital from Dec 2016 to Jan 2021 were enrolled in the study and divided into the immune tolerance phase group, the immune clearance phase group, the low replication phase group, and the re-active phase group. The hepatitis B surface antigen(HBsAg) and liver function indexes were compared among the four groups, the levels of serum ferritin(SF) and serum iron(SI) were detected, and the receiver operating characteristic(ROC) curves were drawn to analyze the values of the SF and SI in prediction of reactive phase of the HBV infection patients. RESULTS There were significant differences in the levels of SF, SI, HBsAg, aspartate aminotransferase(AST), γ-glutamyl transpeptidase(γ-GT) and total bilirubin(TBIL) among the four groups(P<0.05). Set the immune clearance phase of HBV infection as the control, ROC curve analysis showed that the area under curve(AUC) of the SF was the highest in prediction of the reactive phase of HBV infection, the cut-off value was set as 339.05μg/L, the sensitivity of the SF was 73.21% in prediction of the reactive phase of HBV infection, the specificity 56.34%;the sensitivity of the parallel test(SF>339.05 μg/L or SI>33.32 μmol/L)was the highest(85.71%), the specificity of the serial test(SF>339.05 μg/L and SI>33.32 μmol/L) was the highest(92.96%). CONCLUSION The SF and SI of the HBV infection patients show characteristic changes in different clinical stages, both of them can be served as biomarkers for prediction of reactive phase of HBV infection.