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为乙肝设计的简易血检

By LabMedica International staff writers
Posted on 07 Aug 2018
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图片:麦道尼克M系列M32验血系统(图片蒙Boule Medical公司惠赐)。
图片:麦道尼克M系列M32验血系统(图片蒙Boule Medical公司惠赐)。

病毒性肝炎是全球性的重大健康问题,估算表明,2013年乙肝造成全球145万例病毒性肝炎相关死亡中的一半左右。

 

研究人员设计了一项便宜的简易血检,可广泛用于中低收入国家,有助于确定哪些乙肝病人需要立即治疗。这款平价检验产品的原理是测量乙肝病毒e抗原(HBeAg)以及肝脏内丙氨酸转氨酶(ALT)的水平,以得到一个诊断分值。

 

法国巴黎的巴斯德研究所(www.pasteur.fr)率领一个国际科学家小组,对冈比亚804例慢性乙肝病毒感染进行逐步逻辑回归分析,得出了一个表示治疗资格的分值。他们随后用外部的327例乙肝病毒感染,有些是来自塞内加尔和布基纳法索的非洲人,有些来自欧洲。科研小组开发并确证了一个称为TREAT-B(非洲乙肝病毒治疗资格)的诊断分值,它依托中低收入国家本地实验室十分普遍的简易血检,不依赖于乙肝病毒DNA、肝化验或无创肝纤维化诊断(Fibroscan)

 

HBsAg阳性的受试者进行了标准化的临床分期,包括空腹瞬时弹性成像、腹部超声成像、血检(瑞典Boule Medical公司的麦道尼克;www.boule.com)、生化检验(美国新泽西州RaritanOrtho公司的VITROS 350分析仪;www.orthoclinicaldiagnostics.com)、乙肝病毒e抗原(HBeAg; 意大利萨卢贾Diasorin公司的ETI-EBK Pluswww.diasorin.com)以及用研究所自制的实时聚合酶链反应检测乙肝病毒DNA,检测限是50 IU/毫升。

 

科研小组报道,几个参数中的两个仍保留在最终模型里,即乙肝病毒e抗原(HBeAg)ALT水平,组成一个简单的分值(非洲乙肝病毒治疗资格:TREAT-B)。确证数据集的分值在接受者操作特征曲线下呈现高面积(0.85, 95% CI 0.790.91)。分值为2及以上(HBeAg阳性且ALT 20U/升或HBeAg阴性且ALT 40U/升)判断治疗资格的灵敏度与特异性分别为85%77%。世界卫生组织基于天冬氨酸转氨酶与血小板比率(APRI)以及ALT定的灵敏度与特异性分别为90%40%

 

该研究的论文发表于201871日的《肝病杂志》(Journal of Hepatology)。作者总结说,TREAT-B代表着简单便宜的诊断分值,前景诱人,能帮助非洲的医生轻松识别哪些乙肝病毒感染者需要治疗。它有利于中低收入国家升级乙肝治疗项目并去中心化,也许有助于全世界消灭乙肝病毒。中低收入国家广泛开展ALTHBeAg的测量,二者的总成本不到10美元,比常规检验的成本低得多。

Related Links:

巴斯德研究所>>> www.pasteur.fr

Boule Medical股份有限公司>>> www.boule.com

Ortho >>> www.orthoclinicaldiagnostics.com

Diasorin >>> www.diasorin.com


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