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目的:探讨不同病毒载量对慢性乙型肝炎患者红细胞参数的影响及其临床意义。方法:选取兰州大学第一医院确诊为慢性乙型肝炎的患者373例,其中丙氨酸转移酶(alanine transaminase,ALT)正常的慢性乙型肝炎患者123例(ALT<40 U/L),ALT大于等于正常上限、且小于2倍增高的慢性乙型肝炎患者128例(40U/L≤ALT<80 U/L),ALT大于等于正常上限2倍增高的慢性乙型肝炎患者122例(ALT≥80 U/L)。采用全自动血细胞分析仪检测血常规参数,采用全自动生化分析仪检测肝功能,采用荧光定量PCR分析仪检测被测者的病毒载量,用协方差分析检验在不同病变阶段中病毒载量对慢性乙型肝炎患者红细胞参数的影响。结果:在ALT正常组中,病毒载量对红细胞系统参数影响较弱,而在ALT异常组中,病毒载量对红细胞系统参数有明显影响,且以ALT≥正常上限2倍组中为甚,具体表现为随着病毒载量的增加,红细胞计数[低复制组(4.10±0.67)×1012/L,中复制组(3.92±0.69)×1012/L,高复制组(3.54±0.90)×1012/L]、血红蛋白[低复制组(129.66±21.12)g/L,中复制组(126.23±23.38)g/L,高复制组(112.98±27.77)g/L]、红细胞压积(低复制组37.66±5.68,中复制组37.03±6.03,高复制组33.34±8.15)降低(P=0.006,0.007,0.010),而红细胞平均体积[低复制组(92.17±6.53)f L,中复制组(94.85±7.95)f L,高复制组(101.63±11.33)f L]、红细胞平均血红蛋白量[低复制组(31.70±2.22)pg,中复制组(33.11±3.62)pg,高复制组(34.65±3.13)pg]、红细胞平均血红蛋白浓度[低复制组(344.28±17.17)g/L,中复制组(351.33±16.90)g/L,高复制组(358.12±15.67)g/L]、红细胞分布宽度标准差[低复制组(52.49±9.04)f L,中复制组(56.96±7.19)f L,高复制组(61.23±7.23)f L)]升高(P=0.000,0.000,0.002,0.000)。结论:通过观察病毒载量对慢性乙型肝炎患者红细胞参数的影响,可以反映在不同病变阶段乙型肝炎病毒与免疫反应的关系,以及对肝功能的影响,可以为临床抗病毒治疗提供理论支持。
Objective: To investigate the effect of different viral load on erythrocyte parameters in patients with chronic hepatitis B and its clinical significance. Methods: A total of 373 CHD patients diagnosed as CHB were selected from the First Hospital of Lanzhou University. There were 123 patients with ALT (normal ALT), ALT <40 U / L, ALT 128 patients with chronic hepatitis B (40U / L≤ALT <80 U / L) whose ALT was greater than or equal to the normal upper limit and less than 2-fold increase, 122 patients with ALT≥2times higher than the upper limit of normal (ALT≥ 80 U / L). The hematological parameters were detected by automatic hematology analyzer. The liver function was detected by automatic biochemical analyzer. The fluorescence quantitative PCR analyzer was used to detect the viral load and the covariance analysis was used to test the effect of viral load in different pathological stages Effect of erythrocyte parameters on chronic hepatitis B patients. Results: In the normal ALT group, the viral load had a weak effect on the erythrocyte system parameters. In the abnormal ALT group, the viral load had a significant effect on the erythrocyte system parameters, The results showed that with the increase of viral load, the number of erythrocytes in erythrocyte group (4.10 ± 0.67 × 1012 / L, 3.92 ± 0.69 × 1012 / L, 3.54 ± 0.90 × 1012 / / L], hemoglobin (129.66 ± 21.12 g / L, 126.23 ± 23.38 g / L, 112.98 ± 27.77 g / L], hematocrit 37.66 ± 5.68, and 37.03 ± 6.03 in the replication group and 33.34 ± 8.15 in the high replication group, respectively) (P = 0.006,0.007,0.010), while the average volume of erythrocytes [low replication group (92.17 ± 6.53) f L, middle replication group ± 7.95) f L, high copy group (101.63 ± 11.33) f L], mean erythrocyte hemoglobin content [low copy group (31.70 ± 2.22) pg, medium copy group (33.11 ± 3.62) pg and high copy group (34.65 ± 3.13) ), the average hemoglobin concentration in erythrocytes (344.28 ± 17.17 g / L in the low-copy group, 351.33 ± 16.90 g / L in the high-copy group and 358.12 ± 15.67 g / L in the high-copy group) Poor [low copy group (52.49 ± 9.04) f L , Middle copy group (56.96 ± 7.19) f L, high copy group (61.23 ± 7.23) f L)] (P = 0.000,0.000,0.002,0.000). Conclusion: The effect of viral load on erythrocyte parameters in patients with chronic hepatitis B can reflect the relationship between hepatitis B virus and immune response and its effect on liver function in different stages of disease, which can provide theoretical support for clinical antiviral therapy .