慢性乙肝患者HBV-DNA、肝功能指标与肝纤维化的关系

目的]探究慢性乙型病毒性肝炎患者乙肝病毒脱氧核糖核酸(HBV-DNA)、肝功能指标与肝纤维化的关系。方法]入选65例慢性乙肝患者为患者组;同期选取肝功能合格的体检者65例作为对照组;检测2组肝纤维化指标血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)],HBV-DNA,肝功能指标总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆汁酸(TBA)、白蛋白(ALB)]和血小板计数(PLT);并通过SPSS 22.0对所得数据进行相关性分析。结果]患者组的肝纤维化指标HA:(207.8±120.1)ng/ml、LN:(160.02±94.23)ng/ml、PCⅢ:(143.22±67.82)ng/ml、Ⅳ-C:(123.53±81.72)ng/ml、血清HBV-DNA(5.76±1.22)均显著高于对照组(P<0.05)。患者组中的重度乙肝患者肝纤维化指标与血清HBV-DNA均显著高于轻度及中度乙肝患者(P<0.05)。患者组HA、LN、PCⅢ水平在不同HBV-DNA载量水平(<10³ IU/ml、10³~10⁶ IU/ml、≥106 IU/ml)中比较差异有统计学意义(P<0.05)。经分析除TBIL外,患者组与对照组ALT、AST、TBA、ALB、PLT比较均差异有统计学意义(P<0.05)。患者组中的重度乙肝患者ALT、AST、TBIL、TBA均显著高于轻度及中度乙肝患者(P<0.05),ALB、PLT均显著低于轻度及中度乙肝患者(P<0.05)。血清HBV-DNA载量与LN之间呈正相关关系(r=0.293,P=0.011);血清HBV-DNA载量与HA、PCⅢ、Ⅳ-C之间相关性较弱。患者组肝纤维化与肝功能及PLT之间表现出部分或全部的相关性(P<0.05),其中与ALB、PLT呈负相关;肝纤维化HA相关性最强,其次依次为PCⅢ、LN和Ⅳ-C。结论]慢性乙肝患者HBV-DNA水平与除LN外其余肝纤维化指标之间均无相关性;肝功能指标与肝纤维化、PLT之间相关性较强,HA相关性最为显著;因此,可综合考虑LN、HA、PLT以及肝功能指标对肝纤维化进行诊断。

Relationship between HBV-DNA,liver function index and liver fibrosis in patients with chronic hepatitis B

Objective]To investigate the relationship between HBV-DNA,liver function and liver fibrosis in patients with chronic hepatitis B.Methods]Sixty-six patients with chronic hepatitis B admitted to our hospital from June 2017 to October 2018 were enrolled in the study group.Sixty-five patients who underwent physical examination at the physical examination center of our hospital and with normal liver function were selected as controls.The liver fibrosis index,HBV-DNA,liver function index and platelet count(PLT)were detected,and the correlation data were analyzed by SPSS 22.0.Results]Hepatic fibrosis index HA,LN,PCIII,IV-C and HBV-DNA were(207.8±120.1)ng/ml,(160.02±94.23)ng/ml,(143.22±67.82)ng/ml,(123.53±81.72)ng/ml and(5.76±1.22),which were significantly higher than the control group(P<0.05).The indexes of liver fibrosis(HA,LN,PCⅢ,Ⅳ-C)and serum HBV-DNA in patients with different severity of hepatitis B were significantly higher than those in mild and moderate patients(P<0.05).The levels of HA,LN and PCIII in the patients were significantly different at different HBV-DNA load levels(<10³ IU/ml,10³-10⁶ IU/ml,≥10⁶ IU/ml)(P<0.05).Except for TBIL,there were significant differences in ALT,AST,TBA,ALB and PLT between the patient group and the control group(P<0.05).The ALT,AST,TBIL,TBA of severe patients in patients group were significantly higher than that in mild and moderate patients and had statistical differences(P<0.05).The ALB,PLT of severe patients in patients group were significantly lower than that in mild and moderate patients and had statistical differences(P<0.05).There was a positive correlation between serum HBV-DNA load and LN(r=0.293,P=0.011);serum HBV-DNA load was weakly correlated with HA,PCIII and IV-C.Hepatic fibrosis(HA,LN,PCIII,IV-C)showed partial or complete correlation between liver function(ALT,AST,TBIL,TBA,ALB)and PLT(P<0.05).Among them,ALB and PLT were negatively correlated,and liver fibrosis HA was the strongest,followed by PCIII,LN and IV-C.Conclusion]There is no correlation between HBV-DNA levels in patients with chronic hepatitis B and other indicators of liver fibrosis except LN.The correlation between liver function indexes and liver fibrosis and PLT is strong,and HA correlation is the most significant;therefore,hepatic fibrosis can be diagnosed by considering LN,HA,PLT and liver function indicators.