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目的探讨慢乙肝患者的乙肝五项(HbsAg、HbsAb、HbeAg、HbeAb、HbcAb)、乙肝DNA(HBV-DNA)和甲状腺参数(TSH、FT_3、TT_3、FT_4、TT_4)的临床意义。方法收集在本院2014年6月至2014年12月住院的慢乙肝患者106例,其中慢乙肝轻度患者29例(慢乙肝轻度组)、慢乙肝中度患者57例(慢乙肝中度组)、慢乙肝重度患者20例(慢乙肝重度组)和正常体检者为30例(对照组)。检测其血清的HbsAg、HbsAb、HbeAg、HbeAb、HbcAb、HBV-DNA、TSH、FT_3、TT_3、FT_4、TT_4,并进行统计分析。结果(1)慢乙肝组的TT_3、FT_4、TT_4与对照组相比,差异明显有统计学意义(P<0.001);TSH、FT_3无明显变化(P>0.05)。(2)FT_4、TT_4在慢乙肝轻度组、慢乙肝中度组、慢乙肝重度组和对照组中比较,差异具有统计学意义(P<0.001);慢乙肝重度组的TT_3与轻度组和中度组比较差异有统计学意义(P<0.05)。FT_4在慢乙肝随病情的轻重呈现降低的趋势,慢乙肝重度组和中度组的FT_4水平均低于对照组(P<0.05)。TT_4在慢乙肝加重呈现升高的趋势,但是升高不明显;慢乙肝三组和对照组相比,差异有统计学意义(P<0.05)。(3)慢乙肝组中,TT_3在大三阳组和小三阳组差异有统计学意义(P<0.05)。在DNA≤20IU/mL,大、小三阳两组中的所有检测项目差异不具有统计学意义(P>0.05);在DNA>20 IU/mL中,大、小三阳两组中的TT_3差异具有统计学意义(P<0.05),其余的项目差异不具有统计学意义(P>0.05)。进一步分析TT_3在慢乙肝中度组中的表达,提示在DNA阳性(>20 IU/mL)且大三阳的慢乙肝中度患者的TT_3水平明显高于小三阳(P<0.05)。结论慢乙肝患者血清TT_3和FT_4水平随病情的加重呈现明显降低,与大小三阳无直接关系。DNA阳性(>20 IU/mL)的大三阳慢乙肝中度患者的血清TT_3水平高于DNA阳性的小三阳组。通过检测和监测慢乙肝中度患者的甲状腺激素水平,有助于评估患者的病情和预后判断。
Objective To investigate the clinical significance of hepatitis B (HbsAg, HbsAb, HbeAg, HbeAb, HbcAb), hepatitis B DNA (HBV-DNA) and thyroid parameters (TSH, FT_3, TT_3, FT_4, TT_4) in patients with chronic hepatitis B Methods A total of 106 chronic hepatitis B patients admitted to our hospital from June 2014 to December 2014 were collected. Among them, 29 patients with mild chronic hepatitis B (mild chronic hepatitis B) and 57 patients with moderate chronic hepatitis B (moderate chronic hepatitis B Group), 20 patients with chronic hepatitis B severe (chronic hepatitis B severe group) and 30 normal subjects (control group). The serum HbsAg, HbsAb, HbeAg, HbeAb, HbcAb, HBV-DNA, TSH, FT_3, TT_3, FT_4 and TT_4 were detected and analyzed statistically. Results (1) The TT_3, FT_4 and TT_4 in chronic hepatitis B group were significantly different from those in control group (P <0.001). There was no significant change in TSH and FT_3 (P> 0.05). (2) FT_4 and TT_4 in the chronic hepatitis B mild group, moderate chronic hepatitis B group, chronic hepatitis B severe group and the control group, the difference was statistically significant (P <0.001) Compared with the moderate group, the difference was statistically significant (P <0.05). FT_4 in chronic hepatitis B decreased with the severity of the disease trend, chronic hepatitis B severe group and moderate FT_4 levels were lower than the control group (P <0.05). TT_4 increased gradually in chronic hepatitis B, but the increase was not obvious. There was significant difference between chronic hepatitis B and control group (P <0.05). (3) In chronic hepatitis B group, the difference of TT_3 between Dasanyang group and Xiaosanyang group was significant (P <0.05). There was no significant difference in all test items in DNA≤20IU / mL, big and small Sanyang groups (P> 0.05); in DNA> 20IU / mL, Statistical significance (P <0.05), the remaining items were not statistically significant differences (P> 0.05). Further analysis of TT_3 expression in chronic hepatitis B moderate group, suggesting that DNA positive (> 20 IU / mL) and Sansheng moderate chronic hepatitis B patients with moderate TT3 levels were significantly higher (3) (P <0.05). Conclusions Serum levels of TT_3 and FT_4 in patients with chronic hepatitis B are significantly decreased with the severity of the disease, and are not directly related to the size of Sanyang. The serum TT_3 level of DNA positive (> 20 IU / mL) patients with moderate hepatitis B moderate hepatitis B was higher than that of DNA positive Xiaosanyang group. By detecting and monitoring thyroid hormone levels in patients with moderate chronic hepatitis B, it is helpful to assess the patient’s condition and prognosis.