乙型肝炎患者ALT水平与HBV血清标志物联合检测的应用价值

Value of combined detection of ALT and serological markers of HBV in patients with hepatitis B

目的研究谷丙转氨酶(ALT)、乙型肝炎病毒(HBV)血清标志物联合检测对乙型肝炎患者肝功能的诊断价值。方法选取2015年9月-2017年12月宁波市第二医院收治的慢性乙型病毒性肝炎患者59例为慢性乙型肝炎组;肝硬化患者32例为肝硬化组;肝细胞肝癌患者19例为肝癌组。观察和检测三组患者ALT水平和HBV血清标志物定量水平,并对患者肝功能分级进行比较,绘制ALT、HBV受试者工作特征(ROC)曲线。结果三组患者肝功能分级比较差异有统计学意义(P<0.05),慢性乙型肝炎组患者肝功能A级占比最高,肝硬化组B级占比最高,肝癌组C级占比最高;三组乙型肝炎患者ALT水平、HBsAg、HBeAb定量水平比较差异有统计学意义(P<0.05),ALT、HBsAg、HBeAb单一检测及联合检测诊断乙型肝炎患者肝功能曲线下面积(AUC)分别为0.774、0.693、0.511、0.781;ALT、HBsAg、HBeAb联合检测诊断敏感度91.98%、特异性88.16%,均高于单一指标检测;HBsAg定量水平与肝功能分级呈正相关关系,HBeAb定量水平与肝功能呈负相关关系。结论 ALT水平、HBV血清标志物定量水平联合检测相互补充,诊断优势较单一指标检测更为显著,更利于早期诊断乙型肝炎患者肝功能变化,为临床提供全面、及时的信息,从而遏制乙型肝炎患者肝功能恶化,避免肝硬化及肝细胞肝癌发生。

OBJECTIVE To investigate the value of combined detection of alanine aminotransferase(ALT)and serological markers of hepatitis B virus(HBV)in diagnosis of liver function of the patients with hepatitis B.METHODS A total of 59 patients with chronic hepatitis B who were treated in Ningbo Second Hospital from Sep 2015 to Dec 2017 were chosen as the chronic hepatitis B group,32 patients with liver cirrhosis were chosen as the liver cirrhosis group,and 19 patients with hepatocellular carcinoma were set as the liver cancer group.The levels of ALT and serological markers quantification of HBV of the three groups of patients were detected and observed,the liver function was classified and compared,and the receiver operating characteristic(ROC)curve of ALT and HBV was drawn.RESULTS There was significant difference in the grade of liver function among the three groups of patients(P<0.05).The proportion of the patients with grade A liver function was the highest in the chronic hepatitis B group,the proportion of the patients with grade B liver function was the highest in the liver cirrhosis group,and the proportion of the patients with grade C liver function was the highest in the liver cancer group.There were significant differences in the ALT level,HBsAg and HBeAb quantification levels among the three groups of patients(P<0.05).The areas under curve(AUCs)of single detection of ALT,HBsAg,HBeAb and their combination were respectively 0.774,0.693,0.511 and 0.781 in diagnosis of the liver function of the hepatitis B patients;the sensitivity of the combined detection of ALT,HBsAg and HBeAb was 91.98%,higher than that of the single detection;the specificity of the combined detection was 88.16%,higher than that of the single detection.The HBsAg quantification level was positively correlated with the grade of liver function,and the HBeAb quantification level was negatively correlated with the liver function.CONCLUSION The combined detection of the ALT and serological markers of HBV complement each other and has more remarkable effect on the diagnosis than the single detection,it facilitates the early diagnosis of change of liver function of the hepatitis B patients and provides full-ground and sufficient information for clinical treatment so as to prevent the deterioration of liver function,liver cirrhosis and hepatocellular carcinoma.