外周血内病毒指标及PLT水平对乙肝肝硬化患者病情和预后的影响

程辉

[摘要] 目的 評价病毒指标及PLT水平对乙肝肝硬化患者病情和预后的影响。 方法 选择2016年4月至2020年5月我院收治的乙肝肝硬化患者110例，根据Chid-Pugh肝功能分级标准进行分组，比较各组Child-Pugh评分、病毒指标及PLT水平;根据患者是否发生并发症进行分组，比较两组患者外周血内并发症指标、PLT水平，采用二元Logistic回归分析筛选并发症发生的独立影响因素。 结果 随着肝功能分级的升高，Child-Pugh评分及HBcAb滴度逐渐增加，而HBsAg滴度Log值、HBcAb-IgM滴度及PLT计数逐渐降低，差异有统计学意义（P<0.05）;有并发症组和无并发症HBsAg滴度Log值、HBcAb滴度及PLT计数相比差异有统计学意义（P<0.05）;肝功能Child-Pugh评分与HBsAg滴度Log值、HBcAb-IgM滴度及PLT计数呈负相关（P<0.05），与HBcAb滴度呈正相关（P<0.05）。外周血HBsAg滴度Log值、HBcAb滴度及PLT计数是肝硬化患者并发症发生的独立影响因素（P<0.05）。结论 乙肝肝硬化患者随肝功能分级的增加，患者外周血HBcAb滴度逐渐增加，而HBsAg滴度Log值、HBcAb-IgM滴度及PLT计数逐渐降低，有并发症的肝硬化患者HBsAg滴度Log值、PLT计数水平较低，HBcAb滴度较高，多指标联合检测可用于评估乙肝肝硬化患者病情和预后。

[关键词] 病毒学指标;PLT;乙肝肝硬化;预后

[中图分类号] R512.6          [文献标识码] B          [文章编号] 1673-9701（2021）12-0108-04

Impacts of virus index and PLT level in peripheral blood on the condition and prognosis of patients with hepatitis B cirrhosis

CHENG Hui

Department of Hepatology， Xuzhou Infectious Disease Hospital， Xuzhou   221000， China

[Abstract] Objective To evaluate the impacts of virus index and PLT level on the condition and prognosis of patients with hepatitis B cirrhosis. Methods A total of 110 patients with hepatitis B cirrhosis admitted to our hospital from April 2016 to May 2020 were selected and divided into groups according to Chid-Pugh hepatic function grading standard. And the Child-Pugh score， virus index and PLT level of each group were compared. The patients were divided into groups according to whether complications occurred. The indexes of complications and PLT levels in peripheral blood were compared between the two groups of patients. The independent impacting factors of complications were screened by binary logistic regression analysis. Results With the increase of hepatic function grade， Child-Pugh score and HBcAb titer increased gradually， while HBsAg titer log value， HBcAb-IgM titer and PLT count decreased gradually， with statistically significant differences（P<0.05）. There were statistically significant differences in HBsAg titer log value， HBcAb titer and PLT count between the complication group and the non-complication group（P<0.05）. Child-Pugh score of hepatic function was negatively correlated with HBsAg titer log value， HBcAb-IgM titer and PLT count（P<0.05）， while positively correlated with HBcAb titer（P<0.05）. HBsAg titer log value， HBcAb titer and PLT count in peripheral blood were independent impacting factors of complications in patients with liver cirrhosis（P<0.05）. Conclusion With the increase of hepatic function grade， the HBcAb titer in peripheral blood of patients with hepatitis B cirrhosis gradually increased， while the HBsAg titer log value， HBcAb-IgM titer and PLT count gradually decreased. The HBsAg titer log value and PLT count level were lower and HBcAb titer was higher in patients complicated with liver cirrhosis. Multi-index combined detection can be used to evaluate the condition and prognosis of patients with hepatitis B cirrhosis.

[Key words] Virology index; PLT; Hepatitis B cirrhosis; Prognosis

慢性乙型肝炎（Chronic Hepatitis B，CHB）是严重威胁人类身心健康的疾病之一。据报道，全球范围内约有20亿人感染乙型肝炎病毒（Hepatitis B，HBV），其中2.57亿为慢性感染者，每年约有88.7万人死于乙肝感染相关疾病，肝硬化和原发性肝细胞癌患者中由乙肝所致者分别为30%和45%，在我国这个比例分别为77%和84%[1-2]。肝硬化是目前临床常见的肝胆疾病，由各种慢性肝病发展而来，在我国以乙型肝炎肝硬化最为常见。乙肝肝硬化患者若不及时采取治疗，存在发展为肝癌的较高风险[3]。目前临床上针对乙肝肝硬化诊断的金标准为肝活检，属于有创操作，且可重复性较差，易受个体差异影响[4-5]。因此，寻求操作简便、可重复性好的替代指标以尽早诊断肝硬化已成为临床工作的重点。本研究旨在探讨外周血内病毒指标及血小板对乙肝肝硬化患者病情和预后的影响，为临床工作提供参考。

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