熊娟　　范继荣　　杨昊　　张巧安

[關键词] 乙型肝炎;病毒复制;肝纤维化五项;肝硬化

[中图分类号] R436          [文献标识码] B          [文章编号] 1673-9701（2021）14-0135-04

Clinical application of combined detection of viral replication and five items of liver fibrosis in patients with chronic hepatitis B

XIONG Juan1   FAN Jirong2   YANG Hao2   ZHANG Qiaoan1

1.Department of Laboratory Medicine， Hanchuan People′s Hospital in Hubei Province， Hanchuan   431600， China; 2.Hospital Infection Control Division， Hanchuan People′s Hospital in Hubei Province， Hanchuan   431600， China

[Abstract] Objective To explore the clinical significance of the combined detection of hepatitis B virus （HBV） DNA replication and five items of liver fibrosis， including hyaluronic acid （HA）， type Ⅲ procollagen N-terminal peptide （PⅢPN）， type Ⅳ collagen （CⅣ） ）， laminin （LN） and glycocholic acid （CG） in patients with chronic hepatitis B. Methods A total of 109 patients with chronic hepatitis B diagnosed in Hanchuan People′s Hospital from July 2018 to September 2019 were selected as the research subjects. Forty healthy physical examination subjects were selected as the control group. According to the HBV DNA load， the subjects were divided into low load group（<104 copy/mL， 39 cases）， medium load group [（104-106） copy/mL， 33 cases]， high load group （>106 copy/mL， 37 cases）， control group （<500 copy/mL， 40 cases）. The HBV DNA and five items of liver fibrosis were detected， respectively. The data was statistically analyzed by SPSS19.0 software. Results There was no significant difference in the five items of liver fibrosis between the low， medium-load group and the control group（P>0.05）. There was a statistical difference in the five-item liver fibrosis results between the high-load and control group （P<0.05）. With the increase of HBV DNA load， the value of each test index of liver fibrosis also increased. The area under the ROC curve （AUC） of the five items of liver fibrosis （HA， PⅢPN， CⅣ， LN， CG） was 0.556， 0.763， 0.742， 0.420， 0.695， respectively. Among them， PⅢPN had the largest AUC， indicating that PⅢPN had the highest diagnostic accuracy rate for liver disease than other indicators. The AUC of LN was the smallest， <0.5， indicating that the accuracy rate of its single diagnosis was low. Conclusion The combined detection of HBV DNA load and the five indexes of serum liver fibrosis is a good indicator for monitoring the condition of patients with chronic hepatitis B. The clinic should pay attention to the level of virus replication and liver fibrosis in patients with chronic hepatitis B in time to delay the occurrence of liver cirrhosis.

[Key words] Hepatitis B; Virus replication; Five items of liver fibrosis; Liver cirrhosis

我国是乙型肝炎的高发地区，HBV感染率约60%～70%，其中慢性乙型肝炎患者约2000万例，HBV是肝硬化和肝癌的主要原因[1]。肝癌为肝脏恶性肿瘤有原发性肝癌和继发性肝癌两种，其中原发性肝癌对患者威胁性最大，由于原发性肝癌的有极高的发病率，其主要病因与病毒性肝炎、肝硬化和真菌毒素以及化学致癌物质等因素有关;继发性肝癌（转移性肝癌）主要是癌细胞通过血液循环过程从别的器官转移到肝脏。肝癌患者大部分是由于早期的肝炎病毒感染导致，逐渐发展演化为肝纤维化、肝硬化以及肝癌。肝纤维化的病理特征是肝胶纤维的增长，其中细胞外机制的主要构成也就是我们所说的肝纤五项透明质酸（HA）、Ⅲ型前胶原N端肽（PⅢPN）、Ⅳ型胶原（CⅣ）、层粘连蛋白（LN）、甘胆酸（CG）。HBV感染者从无症状的HBV携带者到严重的重型肝炎，最终形成肝硬化和肝癌其实质就是肝纤维不断累积、发展并破坏肝脏正常结构的过程[2]。肝纤维化是肝硬化的前期病变，是可逆转的，肝硬化是肝纤维化进一步发展的结果，是不可逆的，为了预防肝硬化的形成，就要在肝纤维化发展的过程中及时诊断并给予相应的干预措施。HBV DNA和肝纤维化五项是慢性乙型肝炎患者定期检查的主要实验室指标，为探讨HBV DNA和肝纤维化五项联合检测在慢性乙型肝炎患者病情监测过程中的临床应用价值，本研究对109例患者和40例健康体检者血清检测结果进行了分析研究，现报道如下。……