丙型肝炎病毒抗体及核酸测定的诊断效能分析
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摘要
目的探讨丙型肝炎病毒(HCV)感染患者HCV抗体(HCV-Ab)、HCV核糖核酸(HCV-RNA)水平的变化及其在诊断治疗中的意义。方法随机收集临床诊断为HCV感染患者血清,采用化学发光微粒子免疫检测法测定HCV-Ab,PCR-荧光探针法检测HCV-RNA,同时检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)。根据ALT、AST水平以及HCV-RNA水平分别分为两组,分析比较两组间各指标的变化。同时收集37例临床抗病毒治疗患者的血清,分析治疗前后各指标的变化。结果肝功异常组HCV-Ab、RNA载量对数值水平均高于肝功正常组(P<0.05)。HCV-RNA阳性组HCV-Ab、ALT、AST水平均高于HCV-RNA阴性组(P<0.05)。HCV-Ab、RNA载量对数值诊断丙型肝炎的ROC曲线下面积分别为0.990、0.838。连续观察病例治疗后ALT、AST、RNA载量对数值水平均较治疗前下降(P<0.05);而HCV-Ab治疗前后差异无统计学意义(P>0.05)。结论 HCV-Ab对于丙型肝炎的诊断效能优于RNA载量对数值。ALT、AST及HCV-RNA检测在丙型肝炎治疗监测过程中有重要临床意义。
Objective To explore changes of anti-HCV antibody and HCV-RNA in patients with HCV infection and its clinical significance in diagnosis and treatment of hepatitis C.Methods Serum samples from patients with HCV infection were collected.HCV antibodies were analyzed with a chemiluminescence micro-particle immunoassay method,while a PCR-fluorescent probe method was used to detect HCV-RNA.Concentrations of ALT and AST were also determined.Based on the concentrations of ALT,AST and HCV-RNA,samples were divided into two groups respectively and the changes of different indicators were analyzed and compared.Meanwhile samples from 37HCV-infected patients were collected continuously.Different indicators after treatment were compared with those before treatment.Results HCV-Ab and logarithm values of RNA load in the group with abnormal concentrations of ALT and AST were significantly higher than those in the normal group(P<0.05).HCV-Ab,ALT and AST concentrations in HCV-RNA positive group were significantly higher than those in HCV-RNA negtive group(P<0.05).The areas under receiver operating characteristic curve of HCV-Ab and logarithm values of RNA load were 0.990 and 0.838 respectively.Concentrations of ALT,AST and logarithm values of RNA load after treatment were significantly lower than those before treatment(P<0.05)while there was no significance between HCV-Ab level after treatment and that before treatment(P>0.05).Conclusion The diagnostic performance of HCV-Ab is better than that of logarithm values of RNA load.Determination of ALT,AST and HCV-RNA is of clinical importance in monitoring the effect of hepatitis C treatment.
Objective To explore changes of anti-HCV antibody and HCV-RNA in patients with HCV infection and its clinical significance in diagnosis and treatment of hepatitis C.Methods Serum samples from patients with HCV infection were collected.HCV antibodies were analyzed with a chemiluminescence micro-particle immunoassay method,while a PCR-fluorescent probe method was used to detect HCV-RNA.Concentrations of ALT and AST were also determined.Based on the concentrations of ALT,AST and HCV-RNA,samples were divided into two groups respectively and the changes of different indicators were analyzed and compared.Meanwhile samples from 37HCV-infected patients were collected continuously.Different indicators after treatment were compared with those before treatment.Results HCV-Ab and logarithm values of RNA load in the group with abnormal concentrations of ALT and AST were significantly higher than those in the normal group(P<0.05).HCV-Ab,ALT and AST concentrations in HCV-RNA positive group were significantly higher than those in HCV-RNA negtive group(P<0.05).The areas under receiver operating characteristic curve of HCV-Ab and logarithm values of RNA load were 0.990 and 0.838 respectively.Concentrations of ALT,AST and logarithm values of RNA load after treatment were significantly lower than those before treatment(P<0.05)while there was no significance between HCV-Ab level after treatment and that before treatment(P>0.05).Conclusion The diagnostic performance of HCV-Ab is better than that of logarithm values of RNA load.Determination of ALT,AST and HCV-RNA is of clinical importance in monitoring the effect of hepatitis C treatment.
引文
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[16]郑晓群,余坚,田可港,等.IgG抗体亲和力指数在儿童巨细胞病毒感染诊断中的意义[J].医学研究杂志,2011,40(3):55-57.
[2]Helle F,Duverlie G,Dubuisson J.The hepatitis C virus glycan shield and evasion of the humoral immune response[J].Viruses,2011,3(10):1909-1932.
[3]European Association for the Study of the Liver.EASL clinical practice guidelines:management of hepatitis C virus infection[J].J Hepatol,2011,55(2):245-264.
[4]Maudar KK,Gandhi P,Mishra PK,et al.Novel approach for quantification of hepatitis C virus in liver cirrhosis using real-time reverse transcriptase PCR[J].J Gastrointest Surg,2012,16(1):142-146.
[5]Carreo V,Pardo M,López-Alcorocho JM,et al.Detection of hepatitis C virus(HCV)RNA in the liver of healthy,anti-HCV antibody-positive,serum HCV RNA-negative patients with normal alanine aminotransferase levels[J].J Infect Dis,2006,194(1):53-60.
[6]Kesli R,Ozdemir M,Kurtoglu MG,et al.Evaluation and comparison of three different anti-hepatitis C virus antibody tests based on chemiluminescence and enzyme-linked immunosorbent assay methods used in the diagnosis of hepatitis C infections in Turkey[J].J Int Med Res,2009,37(5):1420-1429.
[7]Maylin S,Martinot-Peignoux M,Ripault MP,et al.Sustained virological response is associated with clearance of hepatitis C virus RNA and a decrease in hepatitis C virus antibody[J].Liver Int,2009,29(4):511-517.
[8]Bukh J,Miller RH,Purcell RH.Genetic heterogeneity of hepatitis C virus:quasispecies and genotypes[J].Semin Liver Dis,1995,15(1):41-63.
[9]Rehermann B.Hepatitis C virus versus innate and adaptive immune responses:a tale of coevolution and coexistence[J].J Clin Invest,2009,119(7):1745-1754.
[10]Zhong J,Gastaminza P,Chung J,et al.Persistent hepatitis C virus infection in vitro:coevolution of virus and host[J].J Virol,2006,80(22):11082-11093.
[11]Gremion C,Cerny A.Hepatitis C virus and the immune system:a concise review[J].Rev Med Virol,2005,15(4):235-268.
[12]Bowen DG,Walker CM.Adaptive immune responses in acute and chronic hepatitis C virus infection[J].Nature,2005,436(753):946-952.
[13]Han Y,Wang B,Liu H.The novel use of a routine quantitative system to analyze the activity,content and affinity of an antibody to hepatitis B core antigen[J].J Clin Virol,2011,52(4):295-299.
[14]Liu H,Han Y,Wang B.Establishment of a new method for the detection of the affinity of antibody to hepatitis B e antigen by a routine quantitative system[J].Clin Chim Acta,2011,412(11/12):1022-1025.
[15]Liu H,Han Y,Wang B.A simple method to measure antibody affinity against the hepatitis B surface antigen using a routine quantitative system[J].J Virol Methods,2011,173(2):271-274.
[16]郑晓群,余坚,田可港,等.IgG抗体亲和力指数在儿童巨细胞病毒感染诊断中的意义[J].医学研究杂志,2011,40(3):55-57.