2018 年第 6 期 第 13 卷

丙型肝炎病毒RNA载量和肝功能联合检测在丙型肝炎诊断中的意义

Significances of hepatitis C virus RNA and liver function indicators in diagnosis of heptitis C

作者：李娟刘义庆张玥于淼董振芳范刚王长印卢志明张炳昌

英文作者：

单位：250021济南，山东大学附属省立医院临床医学检验部

英文单位：

关键词：丙型肝炎；肝功能指标；丙型肝炎病毒；核糖核酸

英文关键词：

• 摘要：

• 【摘要】目的    探讨超敏丙型肝炎病毒（HS-HCV）RNA载量与肝功能指标联合检测在丙型肝炎诊断中的临床意义。方法    选取2016年1月至2017年6月在山东大学附属省立医院确诊为丙型肝炎的患者904例。采用实时荧光定量聚合酶链反应法检测HS-HCV RNA；全自动生化分析仪检测肝功能指标，包括总胆红素、直接胆红素（DBIL）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和α-L-岩藻糖苷酶（AFU）水平。采用受试者工作特征曲线分析肝功能指标对丙型肝炎的诊断价值。结果    女性患者的HS-HCV RNA阳性率明显高于男性［53.4%（230/431）比43.3%（205/473）］（χ2＝9.076，P＜0.05）。HS-HCV RNA载量不同分组间总胆红素、DBIL、AST、ALT和AFU异常率差异均有统计学意义（均P＜0.01）。丙型肝炎患者肝功能指标异常率最高的是AST（40.3%）。肝功能指标单项检测曲线下面积最高的是AST（0.765），联合检测的曲线下面积为0.853；AST诊断丙型肝炎的灵敏度最高（74.8%），ALT诊断丙型肝炎的特异度最高（79.7%），联合检测的灵敏度（77.8%）和特异度（78.0%）均高于单项检测。结论    HS-HCV RNA载量反映了病毒复制和病程的变化，与肝功能检测结果明显相关。HS-HCV RNA载量及肝功能单项检测与联合检测对于丙型肝炎均有诊断价值，可以全面了解患者的病情进展与转归，为患者治疗提供可靠的依据。

• 【Abstract】Objective    To explore the clinical significances of hypersensitive hepatitis C virus（HS-HCV） RNA and liver function indicators in diagnosis of heptitis C. Methods    Totally 904 patients with hepatitis C were enrolled from January 2016 to June 2017 in Shandong Provincial Hospital Affiliated to Shandong University. HS-HCV RNA was detected by the real-time fluorescent quantitative polymerase chain reaction. Levels of total bilirubin（TBIL）, direct bilirubin（DBIL）, aspartate aminotransferase（AST）, alanine aminotransferase（ALT） and α-L-fucosidase（AFU） were detected by the automatic biochemical analyzer. Values of liver function indicators in diagnosis of heptitis C were analyzed by the receiver operating characteristic（ROC） curve. Results    Positive rate of HS-HCV RNA in female patients was significantly higher than that in male patients［53.4%（230/431） vs 43.3%（205/473）］（χ2＝9.076, P＜0.05）. Abnormal rates of TBIL, DBIL, AST, ALT and AFU showed significant differences among groups with different HS-HCV RNA（P＜0.01）. Abnormal rate of AST was the highest in hepatitis C patients（40.3%）. Area under curve of AST in diagnosis of heptitis C was 0.765; area under curve of combined detection of 5 liver function indicators was 0.853. The sensitivity of AST（74.8%） and the specificity of ALT（79.7%） was the highest in diagnosis of heptitis C; combined detection showed higher sensitivity（77.8%） and specificity（78.0%）. Conclusions    HS-HCV RNA can reflect virus replication and course of hepatitis C; it is associated the levels of liver function indicators. HS-HCV RNA and liver function indicators have good diagnostic values for hepatitis C.