HBVDNA与PreS1以及ALT联合检测乙型肝炎的临床意义

目的分析HBVDNA与PreS1以及ALT在乙型肝炎患者血清中的检测情况，分析其相互关系，评价其联合检测的价值。方法采用荧光定量PCR法检测HBVDNA，同时用ELISA方法检测PreS1蛋白、动力学方法检测ALT，并分析其相互关系。结果HBeAg阳性组中HBVDNA、PreS1检出率分别为97．1％、94．3％（x^2=0．17，P〉0．05）。HBsAg＋、抗HBe＋和抗HBc＋组中HBVDNA、PreS1的检出率分别为47．4％、73．7％，表明部分HBeAg阴性、抗HBe＋患者仍有病毒复制。HBsAg＋、抗HBc＋组巾HBVDNA、PreS1的检出率分别为65．8％、89．5％，而ALT在这3组中的异常率差异无统计学意义（x^2分别为2．18、1．93、0．03，均P〉0．05），说明血清ALT虽对肝细胞损害极为敏感但缺乏特异性。ALT异常组中HBVDNA和PreS1检出率分别为78．6％、86．3％，两者相关性较高（x^2=2．64，P〉0．05），ALT正常组中HBVDNA和PreS1检出率差异有统计学意义（x^2=9．68，P〈0．01）。PreS1与HBVDNA检出率不一致，可能是PreS1和HBVDNA检测所表达的意义并不完全一致。结论HBVDNA、PreS1以及ALT在乙型肝炎患者血清中所表达的意义各有侧重，在实际工作中应联合检测，互相补充，这样对乙型肝炎患者的诊断与治疗会有更高的临床价值。

Clinical significance of combined detection of HBV DNA,PreS1 and ALT in patients with hepatitis B

Objective To analyze the association of HBV DNA, PreS1 with ALT, and evaluate the clinical value of combined detection. Methods Fluorescence quantitative PCR was applied to detec ting HBV DNA, enzyme linked immunosorbent assay （ELISA） was adopted to measure PreS1 pro tein, and kinetic method was employed to measure serum level of alanine aminotransferase （ALT）. The teat results were compared and analyzed. Results The detection rates of HBV DNA and PreS1 were respectively 97. 1 % and 94.3% in HBeAg positive group, with a highly positive correlation （x^2 =0.17, P〉0.05）, while in the HBsAg＋, anti-HBe＋ and anti-HBc ＋ group, the detection rates were respectively 47.4% and 73. 7% , indicating that the viral replication still occurred in some pa tients with anti-HBe positive, HBeAg negative. The detection rates of HBV DNA and PreS1 were re spectively 65.8% and 89.5% in HBsAg＋, anti HBc ＋ group. However, the detection rates of ALT in these three groups were no significant difference （x^2 was 2.18, 1.93 and 0.03 respectively, P〉0. 05）. It was illustrated that the ALT was sensitive to hepatocyte damage but not specific. The detection rates of HBV DNA and Presl were respectively 78.6% and 86.3% in ALT abnormal group, with high positive correlation （x^2= 2.64,P2〉0.05）. While in the group of normal ALT group, HBV DNA and Presl detection rates were quite different, showing their different clinical significance （x^2= 9.68, P〈0.01）. Conclusion The clinical value of HBV DNA, Presl and ALT in HBV patients is different, so combined detection shoule be performed so as to improve diagnosis and treatment of hepatitis B.