基于化学发光免疫技术评估乙型肝炎抗体定量指标对乙型肝炎感染的诊断意义

发布时间：2018-06-02 08:16

本文选题：乙型病毒性肝炎 + 乙型病毒性肝炎病毒标志物　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：建立一个全新的、准确的、科学的、且简便易行的评价体系，不仅能恰当地反映乙肝病毒血清学标志物的临床检测意义，而且能帮助检验人员及临床医师简便正确地判断疾病，分析疾病的转归，从而使乙肝“二对半”标志物检测能更好地应用于临床。方法：1.随机选取来大连市中心医院和大连市第二人民医院测定了“二对半”水平的人群组成研究样本，并按如下标准筛选： ①AST/ALT均＜40U/L和HBsAg阴性，HBsAb、HBeAb、HBcAb至少有一项阳性者即入选； ②AST/ALT均＞40U/L和HBsAg阳性，HBsAb、HBeAb、HBcAb至少有一项阳性者即入选； ③仅HBsAb一项阳性者从入选研究样本中剔除。采用以上的标准共收集到了213例年龄65±12.7岁之间人群的临床资料作为研究样本，其中男性107例，女性106例。以AST和ALT均正常（肝脏酶学正常组）、AST和ALT均异常（肝脏酶学异常组）进行分组，共有107名肝脏酶学正常者（男55例，女52例）和106名肝脏酶学异常者（男54例，女52例）。又随机选取了507例（男267例，女240例，年龄54±13.5岁）来大连市中心医院和大连市第二人民医院测定了“二对半”水平的人群组成验证样本。 2.采用ROC分析、散点图、秩和检验等统计学方法确立研究样本中HBsAb、HBeAb、HBcAb等的界值（cutoff值）如下： ①HBsAb测量数据凡≤9.9IU/L，抗体指数赋值为1；凡＞9.9IU/L，抗体指数赋值为0； ②HBcAb测量数据凡≤0.01COI，抗体指数赋值为0；凡＞0.01COI，抗体指数赋值为1； ③HBeAb测量数据凡≤1.8COI，抗体指数赋值为0；凡＞1.8COI，抗体指数赋值为1；同时，引入抗体指数的定义：抗体指数值等于HBsAb、HBcAb、HBsAb赋值数的和。并计算抗体指数值，建立抗体指数评价体系； 3.使用验证样本检验建立的抗体指数评价体系，结合临床实际应用，归纳总结成果。结果：1.三种抗体的赋值界值及抗体指数值： ①HBsAb测量数据凡≤9.9IU/L，抗体指数赋值为1；凡＞9.9IU/L，抗体指数赋值为0； ②HBcAb测量数据凡≤0.01COI，抗体指数赋值为0；凡＞0.01COI，抗体指数赋值为1； ③HBeAb测量数据凡≤1.8COI，抗体指数赋值为0；凡＞1.8COI，，抗体指数赋值为1； ④抗体指数的定义：抗体指数值等于HBsAb、HBcAb、HBsAb赋值数的和。 2.肝脏酶学正常时，当抗体指数为0时，有57%的可能性提示机体恢复好或者机体正处于免疫力最强的时期；当抗体指数为1时，占36.4%，中等程度的免疫力，预示着机体有好转的倾向；当抗体指数为2时，虽然预示预后不良，但这种情况的可能性很低，仅为6.5%；当抗体指数为3时，表示机体几乎没有抗体产生。肝脏酶学异常时，当抗体指数为0时，占1.9%；当抗体指数为1时，占67.0%，疾病有可能向着好转的方向发展；当抗体指数为2时，占28.3%，提示机体免疫反应较弱，预后不良；当抗体指数为3时，占2.8%。结论：抗体指数所定量指示的乙型肝炎免疫反应可以较为准确地说明乙型肝炎感染与机体免疫反应的关系并对预后作出判断。
[Abstract]:Objective: to establish a new, accurate, scientific, and convenient evaluation system which can not only reflect the clinical significance of HBV serological markers, but also help the inspectors and clinicians to judge the disease, analyze the prognosis of the disease, and make the "two to half" markers of hepatitis B detected. It is better used in clinical practice.
Methods: 1. randomly selected Dalian City Center Hospital and Dalian City Second People's hospital to determine the "two to half" level of population composition research samples, and according to the following criteria:
(1) all AST/ALT were < 40U/L and HBsAg negative, and HBsAb, HBeAb and HBcAb were enrolled in at least one positive group.
AST/ALT > 40U/L and HBsAg positive, HBsAb, HBeAb, HBcAb at least one positive person was selected.
Only one HBsAb positive person was excluded from the selected study sample.
The above criteria were used to collect the clinical data of 213 people aged 65 + 12.7 years, including 107 male and 106 female, with AST and ALT normal (normal liver enzyme group), AST and ALT abnormality (liver enzyme abnormality) group, and there were 107 normal liver enzymes (55 men, 52 women) and 106. The liver enzymes were abnormal (54 males and 52 females).
507 cases (267 men, 240 women, 240 women, 54 + 13.5 years old) came to Dalian City Center Hospital and second people's Hospital of Dalian to test the sample of "two half" level.
2. using ROC analysis, scatter plot, rank sum test and other statistical methods to establish the boundary values (cutoff values) of HBsAb, HBeAb and HBcAb in the study samples are as follows:
(1) the HBsAb measurement data were less than 9.9IU/L, the antibody index assignment was 1; if > 9.9IU/L, the antibody index assignment was 0;
(2) if the HBcAb measurement data are less than 0.01COI, the antibody index assignment is 0; if > 0.01COI, the antibody index assignment is 1;
(3) if the HBeAb measurement data are less than 1.8COI, the antibody index assignment is 0; if > 1.8COI, the antibody index assignment is 1;
At the same time, the definition of antibody index is introduced: the antibody index is equal to the sum of HBsAb, HBcAb and HBsAb assignments. The antibody index is calculated and the antibody index evaluation system is established.
3. the establishment of the antibody index evaluation system using validation samples, combined with clinical practice, summarizes the results.
Results: 1. the assignment limits and antibody reference values of the three antibodies:
(1) the HBsAb measurement data were less than 9.9IU/L, the antibody index assignment was 1; if > 9.9IU/L, the antibody index assignment was 0;
(2) if the HBcAb measurement data are less than 0.01COI, the antibody index assignment is 0; if > 0.01COI, the antibody index assignment is 1;
(3) if the HBeAb measurement data are less than 1.8COI, the antibody index assignment is 0; if > 1.8COI, the antibody index assignment is 1;
(4) the definition of antibody index: the sum of antibody index is equal to the sum of HBsAb, HBcAb and HBsAb assignments.
2. when the liver enzyme is normal, when the antibody index is 0, there is a 57% possibility that the body is good or the body is in the strongest immune period; when the antibody index is 1, it is 36.4%, and the moderate immunity indicates the body's tendency to improve; when the antibody index is 2, the prognosis is bad, but the possibility of this situation is possible. The sex is very low, only 6.5%; when the antibody index is 3, there is almost no antibody in the body. When the liver enzyme is abnormal, the antibody index is 0, accounting for 1.9%; when the antibody index is 1, it is 67%, the disease may develop in the direction of improvement; when the antibody index is 2, it is 28.3%, suggesting that the body's immune response is weak and the prognosis is poor; when the immune response is weak When the body index is 3, it accounts for 2.8%.
Conclusion: the immunoreaction of hepatitis B, as indicated by the antibody index, can be more accurate in explaining the relationship between hepatitis B infection and the immune response of the body and judging the prognosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62

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