乙型肝炎患者血清乙型肝炎病毒DNA检测与肝功能酶学指标的相关性

Correlations of serum hepatitis B virus-DNA detection with liver function enzymological indicators in patients with hepatitis B

目的探讨乙型肝炎(乙肝)患者血清乙型肝炎病毒(HBV)DNA检测与肝功能酶学指标的相关性。方法选择2022年4月—2023年5月揭西县中医医院收治的85例乙肝患者作为研究对象,纳入观察组;另外选择同期该院85例健康体检者作为对照组。应用荧光聚合酶链反应(PCR)检测血清HBV-DNA载量;采用酶联免疫吸附试验(ELISA)检测丙氨酸转氨酶(ALT)、α-L-岩藻糖苷酶(AFU)、天冬氨酸转氨酶(AST)、凝血酶原时间(PT)、乙肝表面抗原(HBsAg)、乙肝e抗体(HBeAb)、乙肝表面抗体(HBsAb)、乙肝e抗原(HBeAg)、乙肝核心抗体(HBcAb)。根据HBV病毒载量不同将患者分成阴性组(HBV-DNA<5.0×10^(2)U/mL;45例)、低拷贝组(HBV-DNA为5.0×10^(2)~<1.0×10^(4)U/mL;17例)、中拷贝组(HBV-DNA为1.0×10^(4)~<1.0×10^(6)U/mL;13例)、高拷贝组(HBV-DNA为1.0×10^(6)~1.0×10^(8)U/mL;10例)。比较不同血清学模式下HBV-DNA的定量检测结果和阳性检出率,以及HBV-DNA与HBeAg的阳性率;比较各组肝功能指标水平差异。结果56例小三阳患者中检出19例HBV-DNA阳性,检出率为33.93%,HBV-DNA含量为(4.27±0.13)×10^(6)U/mL;15例大三阳患者中检出11例HBV-DNA阳性,检出率为73.33%,HBVDNA含量为(2.34±0.11)×10^(8)U/mL;10例HBsAg、HBeAg、HBeAb、HBcAb均阳性患者中检出7例HBVDNA阳性,检出率为70.00%,HBV-DNA含量为(1.55±0.09)×10^(7)U/mL;4例HBsAg、HBcAb均阳性患者中检出1例HBV-DNA阳性,检出率为25.00%,HBV-DNA含量为(9.41±0.52)×10^(5)U/mL。85例乙肝患者的HBV-DNA阳性率明显高于HBeAg阳性率(44.71%比29.41%,P<0.05)。乙肝患者中阴性组、低拷贝组、中拷贝组、高拷贝组的ALT、AFU、AST、PT水平均明显高于对照组[ALT(U/L):29.48±5.14、34.16±5.22、35.21±4.69、35.79±5.61比19.52±3.02,AFU(U/L):33.27±4.16、40.66±7.03、66.54±6.57、92.57±12.49比21.48±3.27,AST(U/L):35.29±5.44、50.37±6.29、75.39±8.36、90.25±10.32比19.54±5.03,PT(s):12.46±1.36、13.29±1.02、16.54±1.88、20.43±2.19比11.24±0.16,均P<0.05],且随着HBV复制量增多,AFU、ALT、AST、PT水平均不断升高(均P<0.05)。结论临床上对乙肝患者需定期检测HBV-DNA水平,并及时了解病毒复制情况和肝功能指标变化。

Objective To discuss the correlation of serum hepatitis B virus(HBV)-DNA with liver function enzymological indicators in patients with hepatitis B.Methods The 85 patients with hepatitis B admitted to Jiexi County Hospital of Traditional Chinese Medicine from April 2022 to May 2023 were selected as observation group,and over the same time period,85 healthy checkups were included as control group.Using fluorescence polymerase chain reaction(PCR),the serum HBV-DNA load was detected.Enzyme linked immunosorbent assay(ELISA)was used to detect alanine aminotransferase(ALT),α-L-fucosidase(AFU),aspartate aminotransferase(AST),prothrombin time(PT),hepatitis B surface antigen(HBsAg),hepatitis B e antibody(HBeAb),hepatitis B surface antibody(HBsAb),hepatitis B e antigen(HBeAg)and hepatitis B core antibody(HBcAb).According to the different viral loads,hepatitis B patients were assigned to negative group(HBV-DNA<5.0×10^(2) U/mL;45 cases),low copy group(HBV-DNA was 5.0×10^(2) to<1.0×10^(4) U/mL;17 cases),mediate copy group(HBV-DNA was 1.0×10^(4) to<1.0×10^(6) U/mL;13 cases)and high copy group(HBV-DNA was 1.0×10^(6) to 1.0×10^(8) U/mL;10 cases).The quantitative detection results and positive detectable rates of HBV-DNA under different serological modes were compared,as well as the positive rates of HBV-DNA and HBeAg.The differences in liver function indicators among different groups were compared.Results Among 56 patients with HBsAg,HBeAb and HBcAb positive,19 cases with positive HBV-DNA were detected[positive rate of 33.93%,HBV-DNA of(4.27±0.13)×10^(6) U/mL].Among 15 patients with HBsAg,HBeAg and HBcAg positive,11 cases with positive HBV-DNA were detected[positive rate of 73.33%,HBV-DNA of(2.34±0.11)×10^(8) U/mL].Among 10 patients with HBsAg,HBeAg,HBeAb and HBcAb positive,7 cases with positive HBV-DNA were detected[positive rate of 70.00%,HBV-DNA of(1.55±0.09)×10^(7) U/mL].Among 4 patients with HBsAg and HBcAb positive,one case with positive HBV-DNA was detected[positive rate of 25.00%,HBV-DNA of(9.41±0.52)×10^(5) U/mL].Among 85 patients with hepatitis B,the positive rate of HBV-DNA was significantly higher than that of HBeAg(44.71%vs.29.41%,P<0.05).The levels of ALT,AFU,AST and PT in negative group,low copy group,mediate copy group and high copy group of patients with hepatitis B were significantly higher than those in control group[ALT(U/L):29.48±5.14,34.16±5.22,35.21±4.69,35.79±5.61 vs.19.52±3.02;AFU(U/L):33.27±4.16,40.66±7.03,66.54±6.57,92.57±12.49 vs.21.48±3.27;AST(U/L):35.29±5.44,50.37±6.29,75.39±8.36,90.25±10.32 vs.19.54±5.03;PT(s):12.46±1.36,13.29±1.02,16.54±1.88,20.43±2.19 vs.11.24±0.16;all P<0.05].Wtih the higher viral loads,AFU,ALT,AST and PT were gradually increased(all P<0.05).Conclusion Clinically,it is necessary to regularly detect the level of HBV-DNA in patients with hepatitis B,and timely understand the viral replication and changes in liver function indicators.