本文選題：乙型病毒性肝炎 + 乙型病毒性肝炎病毒標(biāo)志物　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：建立一個(gè)全新的、準(zhǔn)確的、科學(xué)的、且簡(jiǎn)便易行的評(píng)價(jià)體系，不僅能恰當(dāng)?shù)胤从骋腋尾《狙鍖W(xué)標(biāo)志物的臨床檢測(cè)意義，而且能幫助檢驗(yàn)人員及臨床醫(yī)師簡(jiǎn)便正確地判斷疾病，分析疾病的轉(zhuǎn)歸，從而使乙肝“二對(duì)半”標(biāo)志物檢測(cè)能更好地應(yīng)用于臨床。 方法：1.隨機(jī)選取來(lái)大連市中心醫(yī)院和大連市第二人民醫(yī)院測(cè)定了“二對(duì)半”水平的人群組成研究樣本，并按如下標(biāo)準(zhǔn)篩選： ①AST/ALT均＜40U/L和HBsAg陰性，HBsAb、HBeAb、HBcAb至少有一項(xiàng)陽(yáng)性者即入選； ②AST/ALT均＞40U/L和HBsAg陽(yáng)性，HBsAb、HBeAb、HBcAb至少有一項(xiàng)陽(yáng)性者即入選； ③僅HBsAb一項(xiàng)陽(yáng)性者從入選研究樣本中剔除。 采用以上的標(biāo)準(zhǔn)共收集到了213例年齡65±12.7歲之間人群的臨床資料作為研究樣本，其中男性107例，女性106例。以AST和ALT均正常（肝臟酶學(xué)正常組）、AST和ALT均異常（肝臟酶學(xué)異常組）進(jìn)行分組，共有107名肝臟酶學(xué)正常者（男55例，女52例）和106名肝臟酶學(xué)異常者（男54例，女52例）。 又隨機(jī)選取了507例（男267例，女240例，年齡54±13.5歲）來(lái)大連市中心醫(yī)院和大連市第二人民醫(yī)院測(cè)定了“二對(duì)半”水平的人群組成驗(yàn)證樣本。 2.采用ROC分析、散點(diǎn)圖、秩和檢驗(yàn)等統(tǒng)計(jì)學(xué)方法確立研究樣本中HBsAb、HBeAb、HBcAb等的界值（cutoff值）如下： ①HBsAb測(cè)量數(shù)據(jù)凡≤9.9IU/L，抗體指數(shù)賦值為1；凡＞9.9IU/L，抗體指數(shù)賦值為0； ②HBcAb測(cè)量數(shù)據(jù)凡≤0.01COI，抗體指數(shù)賦值為0；凡＞0.01COI，抗體指數(shù)賦值為1； ③HBeAb測(cè)量數(shù)據(jù)凡≤1.8COI，抗體指數(shù)賦值為0；凡＞1.8COI，抗體指數(shù)賦值為1； 同時(shí)，引入抗體指數(shù)的定義：抗體指數(shù)值等于HBsAb、HBcAb、HBsAb賦值數(shù)的和。并計(jì)算抗體指數(shù)值，建立抗體指數(shù)評(píng)價(jià)體系； 3.使用驗(yàn)證樣本檢驗(yàn)建立的抗體指數(shù)評(píng)價(jià)體系，結(jié)合臨床實(shí)際應(yīng)用，歸納總結(jié)成果。 結(jié)果：1.三種抗體的賦值界值及抗體指數(shù)值： ①HBsAb測(cè)量數(shù)據(jù)凡≤9.9IU/L，抗體指數(shù)賦值為1；凡＞9.9IU/L，抗體指數(shù)賦值為0； ②HBcAb測(cè)量數(shù)據(jù)凡≤0.01COI，抗體指數(shù)賦值為0；凡＞0.01COI，抗體指數(shù)賦值為1； ③HBeAb測(cè)量數(shù)據(jù)凡≤1.8COI，抗體指數(shù)賦值為0；凡＞1.8COI，，抗體指數(shù)賦值為1； ④抗體指數(shù)的定義：抗體指數(shù)值等于HBsAb、HBcAb、HBsAb賦值數(shù)的和。 2.肝臟酶學(xué)正常時(shí)，當(dāng)抗體指數(shù)為0時(shí)，有57%的可能性提示機(jī)體恢復(fù)好或者機(jī)體正處于免疫力最強(qiáng)的時(shí)期；當(dāng)抗體指數(shù)為1時(shí)，占36.4%，中等程度的免疫力，預(yù)示著機(jī)體有好轉(zhuǎn)的傾向；當(dāng)抗體指數(shù)為2時(shí)，雖然預(yù)示預(yù)后不良，但這種情況的可能性很低，僅為6.5%；當(dāng)抗體指數(shù)為3時(shí)，表示機(jī)體幾乎沒有抗體產(chǎn)生。肝臟酶學(xué)異常時(shí)，當(dāng)抗體指數(shù)為0時(shí)，占1.9%；當(dāng)抗體指數(shù)為1時(shí)，占67.0%，疾病有可能向著好轉(zhuǎn)的方向發(fā)展；當(dāng)抗體指數(shù)為2時(shí)，占28.3%，提示機(jī)體免疫反應(yīng)較弱，預(yù)后不良；當(dāng)抗體指數(shù)為3時(shí)，占2.8%。 結(jié)論：抗體指數(shù)所定量指示的乙型肝炎免疫反應(yīng)可以較為準(zhǔn)確地說(shuō)明乙型肝炎感染與機(jī)體免疫反應(yīng)的關(guān)系并對(duì)預(yù)后作出判斷。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R512.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 任衛(wèi)國(guó),陳虹,王知秋;金標(biāo)試紙法與ELISA法檢測(cè)無(wú)償獻(xiàn)血者HBsAg結(jié)果比較[J];中國(guó)輸血雜志;2001年01期

2 張書楠;余文輝;周大橋;張春雷;馮玉麗;賀勁松;周小梅;李偉雄;陳雪紅;林卓玲;;乙型肝炎病毒基因型與耐藥病毒株的相關(guān)性研究[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2011年14期

3 莊岳鵬;莊惠萍;吳雙;張純瑜;;影響乙肝表面抗原檢測(cè)結(jié)果的因素及對(duì)策[J];標(biāo)記免疫分析與臨床;2012年06期

4 王懿;洪偉;;346例慢性乙肝患者血清HBV-DNA及前S1抗原檢測(cè)結(jié)果分析[J];標(biāo)記免疫分析與臨床;2013年06期

5 范友蘭;乙型病毒性肝炎的轉(zhuǎn)歸及防治[J];臨床薈萃;1988年S1期

6 王念躍;孫梅;;乙型肝炎實(shí)驗(yàn)室診斷的研究進(jìn)展[J];臨床檢驗(yàn)雜志;2012年11期

7 蘇榮;葉桂樣;羅娜;楊延斌;蔣開平;張勁豐;;乙型肝炎病毒E抗原檢測(cè)方法性能的初步評(píng)價(jià)[J];實(shí)驗(yàn)與檢驗(yàn)醫(yī)學(xué);2013年01期

8 周俊卿;程欣;;乙型肝炎病毒表面抗原定量檢測(cè)的臨床意義及研究進(jìn)展[J];臨床誤診誤治;2013年03期

9 鄒俐;鄭萍;侯連兵;;慢性乙型肝炎患者健康相關(guān)生命質(zhì)量評(píng)價(jià)研究現(xiàn)狀[J];熱帶醫(yī)學(xué)雜志;2012年01期

10 瞿良;王惠萱;李云;滕毅;夏正武;;乙肝血清學(xué)標(biāo)志物定量檢測(cè)及其臨床意義[J];現(xiàn)代檢驗(yàn)醫(yī)學(xué)雜志;2007年06期

本文編號(hào)：1968069