發(fā)布時(shí)間：2018-10-16 09:46

【摘要】：[摘要]目的探討初診HBsAg檢測(cè)陽(yáng)性患者標(biāo)本進(jìn)行抗體中和確證實(shí)驗(yàn)的研究；觀察在CHB四個(gè)不同發(fā)病時(shí)期中,人外周血清中肝臟特異性miRNA-122表達(dá)量的變化和意義；探討血清HBV-DNA低復(fù)制的CHB患者相關(guān)指標(biāo)的變化及意義。方法收集CLIA法定量檢測(cè)HBsAg陽(yáng)性標(biāo)本1974例,應(yīng)用GICA、ELISA等方法復(fù)檢HBsAg并進(jìn)行統(tǒng)計(jì)學(xué)分析；此外,對(duì)CLIA法HBsAg陽(yáng)性而ELISA法陰性的標(biāo)本進(jìn)行了CLIA法中和確證實(shí)驗(yàn)。收集80例CHB患者標(biāo)本,采用FQ-PCR法和CLIA等方法對(duì)miRNA-122、HBV-DNA、HbeAg、HbsAg和ALT進(jìn)行測(cè)定,對(duì)結(jié)果進(jìn)行比較和線性相關(guān)分析。收集HBV-DNA低復(fù)制的CHB患者標(biāo)本229例,進(jìn)行mIL-2R、IL-10、miRNA-122等指標(biāo)進(jìn)行比較分析。結(jié)果對(duì)CLIA法檢測(cè)的HBsAg陽(yáng)性的標(biāo)本使用GICA和ELISA兩種方法進(jìn)行復(fù)檢后發(fā)現(xiàn),GICA和ELISA法檢壩HBsAg均有漏檢現(xiàn)象的發(fā)生,其漏檢率分別占HBsAg陽(yáng)性標(biāo)本的9.1%(180/1974)和25.4%(501/1974),而這些漏檢的標(biāo)本主要集中在CMIA法HBsAg檢測(cè)值≤10.0IU/ml的樣本中,而該濃度范圍標(biāo)本占HBsAg陽(yáng)性標(biāo)本的比例高達(dá)26.90%(531/1974)。本文將180例CMIA法HBsAg陽(yáng)性標(biāo)本而ELISA法漏檢的標(biāo)本經(jīng)CMIA法中和確證實(shí)驗(yàn)陽(yáng)性率為96.67%(174/180)。其中有6例無(wú)法確認(rèn),通過(guò)HBV-DNA檢測(cè)與兩周后隨訪確認(rèn)3例為乙肝病毒感染病例,另3例排除。miRNA-122在CHB患者四個(gè)時(shí)期表達(dá)量均明顯升高,尤其在免疫耐受期和免疫清除期升高顯著(P0.01)；miRNA-122與HbeAg和HBV-DNA相關(guān)性不強(qiáng)(r=0.263,r=0.171),與HbsAg和ALT相關(guān)性較強(qiáng)(r=0.597,r=0.767)。低復(fù)制CHB患者中e抗原陽(yáng)性患者占38.00%,e抗原陰性患者占51.53%；229例患者ALT升高者占總數(shù)的66.81%,患者血漿miRNA-122的表達(dá)量的變化與ALT濃度呈正相關(guān)(r=0.841)。e抗原陽(yáng)性與e抗原陰性組IL-10、mIL-2R濃度與對(duì)照組比較均有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論ELISA等定性方法在低濃度HBsAg標(biāo)本的檢測(cè)上與CLIA等定量方法相比存在明顯不足。實(shí)驗(yàn)室對(duì)首診乙肝HBsAg檢測(cè)的標(biāo)本應(yīng)首選檢測(cè)靈敏度高的CLIA法進(jìn)行檢測(cè),對(duì)低濃度HBsAg陽(yáng)性患者應(yīng)通過(guò)采集雙份血清、中和試驗(yàn)、HBV-DNA檢測(cè)以及隨訪建立檔案等予以確認(rèn),避免漏診誤診。miRNA-122和乙肝病毒復(fù)制可能沒(méi)有關(guān)系,但對(duì)于乙肝的輔助診斷、評(píng)估及健康管理等具有重要的意義.HBV-DNA低復(fù)制CHB患者mIL-2R、 IL-10、miRNA-122等指標(biāo)的變化證明此類患者部分病例仍存在肝細(xì)胞實(shí)質(zhì)性的損害,臨床應(yīng)高度重視,尤其要與非活動(dòng)性乙型肝炎病原攜帶狀態(tài)相鑒別,不可一概而論。
[Abstract]:[abstract] objective to investigate the effect of antibody neutralization assay on HBsAg positive patients, and to observe the changes and significance of liver specific miRNA-122 expression in human peripheral serum during the four different stages of CHB. Objective: to investigate the changes and significance of serum HBV-DNA in CHB patients with low replication. Methods 1974 HBsAg positive specimens were detected by CLIA method, and HBsAg was re-examined by GICA,ELISA and analyzed statistically. In addition, CLIA method was used to confirm the positive samples of CLIA HBsAg and negative ELISA. The samples of 80 patients with CHB were collected. The miRNA-122,HBV-DNA,HbeAg,HbsAg and ALT were measured by FQ-PCR and CLIA. The results were compared and analyzed by linear correlation. Samples of CHB patients with low replication of HBV-DNA were collected and compared with mIL-2R,IL-10,miRNA-122. Results the GICA and ELISA methods were used to re-examine the HBsAg positive specimens detected by CLIA method. The results showed that the HBsAg of the dam detected by GICA and ELISA methods were both missed. The rate of missed detection was 9.1% (180 / 1974) and 25.4% (501 / 1974) of HBsAg positive specimens, respectively. These missed samples were mainly concentrated in samples with HBsAg detection value 鈮，

本文編號(hào)：2273967