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[摘要]目的 分析乙型肝炎病毒前S1蛋白抗原（pre S1）、乙肝两对半、乙肝病毒基因（HBV DNA）联合检测在乙肝患者临床诊断中的应用价值。 方法 选取2011年4月～2014年4月我院住院及门诊收治的160例乙肝患者作为研究对象，于清晨空腹条件下取其血清标本，采用酶联免疫法检测血清pre S1及乙肝两对半水平，同时采用荧光定量扩增技术检测血清内HBV-DNA水平。 结果 大三阳组患者前S1抗原与乙肝HBV DNA阳性率均明显高于其他HBV-M模式，组间对比差异显著（P<0.05），HBsAg阳性HBcAb阳性组前S1抗原阳性率明显高于小三阳组（P<0.05）；前S1抗原阳性组HBV DNA阳性率明显高于对应前S1抗原阴性组，其中以HBsAg+HBeAg+HBcAb+pre S1+组HBV DNA阳性率最高，且其HBV DNA含量水平同样最高；146例HBsAg阳性患者中，137例HbeAg阳性，阳性率为93.8%，且其中HBeAg+组，前S1抗原阳性率为88.9%，明显高于HBeAg-组，组间对比差异显著（P<0.05）；HBsAg阳性患者HBV DNA阳性100例，阳性率68.5%。且HBV DNA阳性组前S1抗原阳性率为85.0%，明显高于HBV DNA-组，提示HBsAg阳性患者血清中pre S1与HBV DNA相关性较强（P<0.05）。结论 采取三项联合检测，可在尽早时间内发现乙肝患者病毒感染情况，为患者的诊断与治疗提供指导。

[关键词]乙型肝炎病毒；前S1抗原；HBV DNA；联合检测；价值

[中图分类号] R512.6 [文献标识码] B [文章编号] 2095-0616（2015）17-146-04

Clinical value analysis of combined detection of Hepatitis B Virus pre S1 protein antigen， five indexes of Hepatitis B and HBV DNA of patients with Hepatitis B in clinical diagnosis

YE Yuanqing LUO Wenshen HUANG Hua LIANG Hongmei CHEN Qun YANG Lianjun BAO Hongxia

Department of Laboratory， Second People's Hospital， Longgang District， Shenzhen 518112， China

[Abstract] Objective To analyze the application value of combined detection of Hepatitis B Virus（HBV） pre S1 protein antigen， five indexes of Hepatitis B and HBV DNA of Patients with Hepatitis B in Clinical Diagnosis. Methods 160 patients with Hepatitis B who were admitted to our hospital from April 2011 to April 2014 were selected as research subjects. Patients serum samples in fasting condition were collected in the morning. Serum pre S1 and five indexes of Hepatitis B were detected by enzyme linked immunoassay and level of HBV DNA in serum was detected by fluorescent quantitative PCR at the same time. Results Positive rates of pre S1 antigen and HBV DNA of patients in the great three positive group was all significantly higher than other HBV-M models. The compared groups have significantly differences （P<0.05）. Positive rates of pre S1 antigen in the HBeAg and HBcAb positive group was significantly higher than that in the small three positive group （P<0.05）. Positive rate of HBV DNA in positive pre S1 antigen group was significantly higher than that in the negative pre S1 antigen group， of which， positive rate of HBV DNA in HBsAg+HBe Ag+HBcAb+pre S1+ group was highest and level of HBV DNA in this group was also highest. Among 146 HBsAg positive patients， 137 were positive HBe Ag patients and positive rate of it was 93.8%. Positive rate of pre S1 antigen was 88.9% in HBeAg+ group which was significantly higher than that of HBeAg-group. These compared groups have significantly differences（P<0.05）. 100 HBV DNA cases were in positive HBsAg patients and the positive rate was 68.5%. Positive rate of pre S1 antigen in positive HBV DNA group was 85.0% which was significantly than that of HBV DNA- group. It suggested that there was a strong correlation between serum pre S1 and HBV DNA in positive HBsAg patients（P<0.05）. Conclusion Combined detection of the three items can discover infection situation of Hepatitis B Virus as soon as possible to give instructions for diagnosis and treatment of patients.endprint

[Key words] Hepatitis B Virus； Pre S1 antigen； HBV DNA； Combined detection； Value

乙肝两对半，即乙肝五项是具有代表性的传统乙肝病毒血清标志物，当前依然作为临床判别乙肝患者病情严重程度及传染性的关键指标，其组合模式较为复杂[1]。有文献提示，其可能受到乙肝病毒变异及药物治疗方案的影响，在反馈乙肝病毒复制及传染性方面有一定的局限性，可能引起误诊与漏诊[2]。基于此，为分析诊断、检测乙肝病毒，提高诊断准确性，降低漏检率的有效方案，我院对收治的160例患者进行了整合研究，现报道如下。

1 资料与方法

1.1 一般资料

选取2011年4月～2014年4月我院住院及门诊收治的160例乙肝患者作为研究对象。所有纳入对象均符合中华医学会颁布的乙型肝炎诊断标准。其中男90例，女70例；年龄22～70岁，平均（41.2±1.3）岁。

1.2 方法

所有患者均于清晨空腹条件下采集其血液标本，保存待测。前S1抗原及乙肝两对半应用酶联免疫法检测，试剂盒购于上海阿尔法生物技术及上海科华生物工程有限公司，按照参照试剂使用说明操作。……