多项指标联合检测对乙型肝炎后肝硬化诊断治疗中的观察分析

目的探讨肝纤维化四项与天门冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)比值、乙型肝炎病毒(HBV)DNA指标联合检测对乙型肝炎(简称乙肝)后肝硬化诊断治疗的临床应用价值。方法选择2009年5月至2011年5月在该院消化内科收治的130例乙肝后肝硬化患者,同时选择80例单纯慢性乙肝为对照组,检测其血清透明质酸(HA)、Ⅲ型前胶原蛋白(PⅢNP)、Ⅳ型胶原蛋白(Ⅳ-Col)、层黏连蛋白(LN)、AST/ALT比值及乙肝DNA(HBV-DNA)指标水平。结果 (1)乙肝后肝硬化血清中HA、Ⅳ-Col、PⅢNP、LN明显高于单纯慢性乙肝组(P<0.01)。(2)肝纤维化四项指标在乙肝后肝硬化血清中HBV DNA>106copy/mL组中除LN外,其他指标水平明显高于乙肝后肝硬化血清中HBV DNA在103～105copy/mL组和HBV DNA<103copy/mL组的水平,差异有统计学意义(P<0.01);在HBV DNA 103～105copy/mL和HBV DNA<103copy/mL两组间肝纤维化四项指标升高水平差异无统计学意义(P>0.05)。(3)肝纤维化四项指标水平在AST/ALT>2、12时为(785.2±216.4)μg/L,各组间差异有统计学意义(P<0.05);Ⅳ-Col升高水平在AST/ALT>2(598.2±158.6)μg/L]和AST/ALT<1(438.7±146.1)μg/L]组间差异统计学意义(P<0.05);PⅢNP和LN升高的水平在各组间差异无统计学意义(P>0.05)。结论联合检测肝纤维化四项与AST/ALT比值、HBV DNA有利于临床对乙肝后肝硬化患者病程的监测,同时为临床对乙肝后肝硬化患者的抗病毒和抗纤维化治疗及疗效的判定提供实验室依据。

Clinical research of combined detection of four indices, AST/ALT ratio, and hepatitis B DNA in diagnosis and treatment of liver cirrhosis after hepatitis

Objective To discuss the clinical application value of combined detection of four indices, AST/ ALT ratio,and hepatitis B DNA in the diagnosis and treatment of liver cirrhosis after hepatitis. Methods 130 cases with posthepatitic cirrhosis of digestive system department from 2009 May to 2011 May in our hospital were select- ed. 80 cases of chronic hepatitis B at the same time were chosen as control group. HA, P Ⅲ NP, Ⅳ-Col, LN, ALT, AST,AST/ALT and HBV DNA level in the serum were detected. Results （1） HA, Ⅳ Col,P ⅢNP, LN in serum of posthepatitic cirrhosis patients were significantly higher than that of simple chronic hepatitis B group （P〈0.01）. （2） Four indices of liver fibrosis in serum of hepatitis B cirrhosis patients with HBV-DNA〉10^6 copy/mL,in addition to LN, the other indices levels were significantly higher than that in patients with HBV-DNA between t03-10S copy/ml and patients with HBV-DNA %103 cop / ml. The difference was significant （P〈0.01）. There was no significant difference in patients with HBV-DNA between 10^3-10^5copy/mL and patients with HBV-DNA 〈10^3 copy/ml （P〉 0.05）. （3） Among AST/ALT〉 2,1〈 AST/ALT〈2 and AST/ALT〈 1 groups, the change of HA was most significant. HA gradually rose following AST/ALT ratio increased, each group has significant difference （P〈0.05）. Col levels elevated in AST/ALT〉 2 and AST/ALT〈 1 groups, and there was significant difference （P〈0.05） ： P U NP and LN levels elevated in each group,but there was no significant difference （P〉0.05）. Conclusion Combined de- tection of four indices,AST/ALT ratio,and hepatitis B DNA was useful for the detection of pathogenesis of patients with liver cirrhosis after hepatitis. And it can provide basis of antiviral and antifibrotic treatment in clinic.