Clinical significance of two semi quantitative detection of hepatitis B

The serum HBV markers (two and half) were determined in the middle of 80s, which played an important role in the diagnosis of hepatitis B, t

Content

The serum HBV markers (two and half) were determined in the middle of 80s, which played an important role in the diagnosis of hepatitis B, the course of disease and the observation of curative effect. With the rapid development of clinical medicine, qualitative detection is far from meeting the requirements of clinical and patients. Due to the detection of antigen antibody qualitative results are not "positive" or "negative", can not dynamically observe the changes in the condition and efficacy, so that the information available for clinical information is limited. With the development of laboratory medicine, the quantitative determination of "two and half" is feasible, which makes up for the deficiency of the qualitative test of ELISA. At the same time, the two semi quantitative detection of serum HBV-DNA and fluorescence quantitative PCR determination of complement each other, comprehensive evaluation of patients with drug efficacy.

One or two the detection sensitivity was greatly improved by semi quantitative detection.

Abbott chemiluminescence immunoassay (Chemiflex) detection of HbsAg sensitivity of 0.1ng/ml and ELISA (ELISA) sensitivity of detection of HBsAg enzyme positive will reach 2ng/ml.

In early 1, acute hepatitis B (Chemiflex): quantitative early detection of HBsAg, confirmed HBV infection, almost can be detected with preS1 at the same time, in the course of observation can greatly shorten the "window period" of time, and the ELISA detection in the early detection of hepatitis B often showed negative HBsAg.

2, some patients with chronic hepatitis B: because the body is often a lack of immune response to HBV envelope protein, the expression of HBsAg was low, ELISA detection showed HBsAg and HbsAb were negative, and (Chemiflex) quantitative detection can avoid these situations, provide the basis for the correct judgement of the disease.

3, if the virus mutates, the expression is low, the conventional ELISA can not detect antigen, and (Chemiflex) quantitative detection with high sensitivity, can be found and most likely to detect HBsAg and HbsAb. Domestic and foreign scholars have shown that the immune response of HBsAg is related to the damage of liver cells. The content of HBsAg in serum was inversely proportional to the immune response of HBsAg cells, and the change of liver function was proportional to the cellular immunity. Quantitative HBsAg is the only means to reflect this relationship.

4, can be found in low concentrations of HBsAg carriers. Especially some groups such as health care workers, families of patients, because of the long-term close contact, but also non direct blood borne infection of acute hepatitis B, but a small amount of long-term infection, and stimulate the body to produce certain immunity, may have a low concentration of infection, especially should pay enough attention by the people, pay close attention to and take measures to prevent the development of chronic hepatitis B or carriers.

Two, dynamic observation of efficacy and disease monitoring

The occurrence and development of diseases, therapeutic effect and prognosis is a dynamic process of change, (Chemiflex) quantitative detection of hepatitis B two pairs of semi the symbol duration, treatment and prognosis of the concentration of hepatitis B can play a full role of dynamic detection, which can provide the basis for the doctor to make a reasonable explanation for the disease effect of treatment.

1, quantitative analysis of HBsAg and HbsAb concentration changes, it can be seen in the recovery period of acute hepatitis B. If the concentration of HBsAg decreases, the concentration of HBsAb increases gradually, which indicates that the disease is developing to the recovery stage. On the contrary, HBsAg concentration is at a high level or upward trend, while HBsAb has been at the bottom level, it is easy to develop into chronic hepatitis B or carriers.

2, quantitative analysis of HBeAg and HBeAb concentration changes, can reflect the change of condition and treatment effect. Quantitative determination of HBeAg to HBeAb conversion period, that is, the performance of HBeAg concentration (NCU) decreased and HBeAb concentration (NCU) increased process. High concentration of HBeAg can indirectly indicate that the virus is in a state of high replication. High concentration of HBeAb on the one hand indicates the improvement of the disease, and in some cases (such as poor liver function indicators) may be associated with liver necrosis, liver cirrhosis, liver cancer.

3, the level of HBcAb can reflect the state of virus infection. The high concentration of HBcAb showed the acute infection of hepatitis B and the decrease of the recovery period. Chronic hepatitis B showed a persistent high concentration of HBcAb. The low concentration of HBcAb is generally the recovery period or previous infection.

4, it is helpful to judge the activity and non activity of chronic hepatitis. The activity of chronic hepatitis B is relatively stable, and the activity is often progressive.

5, the classification of chronic hepatitis B: according to the study of HBV DNA mutations in the C gene, according to HBeAg and HBeAb status are divided into two types: HBeAg positive chronic hepatitis caused by wild type HBV infection, the natural history of HBeAg positive and HBeAb positive period. Quantitative determination of the HBeAg to HBeAb conversion period, that is, the performance of HBeAg concentration (NCU) decreased and HBeAb concentration (NCU) increased process. Another type of HBeAb positive chronic hepatitis is mainly caused by the infection of C gene mutation HBV, also known as chronic hepatitis. HBeAg always does not appear, but for HBV DNA replication. HBsAg also changes at high concentrations. Compared with the former period of transformation of HBeAg positive chronic hepatitis B, two pairs of semi qualitative showed small three, but the latter is mainly manifested in the high concentration of HBsAg, and high and low values of ALT and HBV DNA are always positive. These patients often on interferon and lamivudine therapy.

Three, the determination of serum HBV-DNA fluorescence quantitative PCR can directly reflect the virus replication status, has many clinical value, but it can not fully reflect the replication of the virus in the liver cells of HBV virus in resting state.

HBV-DNA negative is not completely representative of HBV in vivo has been cleared, with the indexes of two half and half "can objectively reflect the in vivo HBV virus, the correct prognosis and treatment.

If HBV - DNA negative and HBsAg, HBeAg, or HBeAb and HBcAb concentrations are higher, suggesting that not fully recovered, it is possible that the virus replication status again, still need to pay close attention to. If HBsAg, HBeAg or HBV-DNA negative HBeAb and HBcAb concentrations were very low or negative and lasts for a period of time, which may be completely cured, good prognosis.

Four, the quantitative determination of HBsAb can make a correct evaluation of whether the antibody has a "neutral" HBV immunity, and play a supervisory role in the prevention of hepatitis B

The content of HBsAb in 10mIU/ml patients with ELISA can be detected in the positive results of HbsAb, but not the body must have immunity, and the content of HBsAb in 10100mIU/ml between samples, qualitative is positive, but the body of HBV immunity is weak, even can not prevent HBV infection, there is still the risk of HBV infection. Only when the content of HBsAb is above 100mIU/ml can be determined to resist the invasion of HBV. The higher the content of HBsAb, the stronger the ability of the body to resist the invasion of HBV, the longer the duration. For the quantitative determination of the content of HBsAb, according to the judgment of the immune effect of the immune state of HBV and hepatitis B vaccine, HBsAb content is low, should strengthen the injection of hepatitis B vaccine, the concentration of HBsAb increased to protect. At the same time, hepatitis B vaccine after the body immunity due to individual differences, and some can produce high concentrations of antibodies and continue for decades. Some people have the antibody concentration is not very high, and the duration is not long, it gradually disappeared after a few years, these people should be concerned about the concentration change of HBsAb, when necessary, should also strengthen the injection of hepatitis B vaccine (but there are also people who believe that the body in the infected by virus, will produce memory response quickly improve immunity). Therefore, it is of great significance to quantitatively evaluate the immunity of hepatitis B vaccine and to prevent the high risk population.

In the treatment of chronic liver disease, the patient is most concerned about the change in his condition. Quantitative determination of HBV serum markers of the concentration that the patient can have a better understanding of their condition, improve the treatment of confidence, but also to strengthen the trust of the doctor, help to improve the doctor-patient relationship, conducive to the treatment of disease.

 

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