The two halves of hepatitis B are also called hepatitis B five items, and its significance lies in: checking whether it is infected with hepatitis B and the specific situation of infection, and distinguishing between big sanyang and small sanyang.
Two-and-a-half examination is a preliminary examination to judge whether you are infected with hepatitis B or to roughly estimate the level of virus replication. Two and a half examinations are of little reference value in evaluating the severity of the disease. Liver function is an important test to measure whether there is necrosis and inflammation in the liver, among which transaminase is the most important, and liver function needs to be regarded as an important reference index for treatment. HBV DNA detection is a reference for judging how to treat it, and also has certain reference significance for infectivity. Generally, the higher the DNA, the more contagious it is, and it needs to be checked together with liver function.
Hepatitis B is divided into two halves.
1(HBsAg- hepatitis B virus surface antigen) is a sign that the virus has been infected, but it does not reflect whether the virus has been replicated, the degree of replication and infectivity.
2(HBsAb- hepatitis B virus surface antibody) is the sign of neutralizing antibody and the main sign of recovery or drug resistance. Hepatitis B vaccination, if only this positive, should be regarded as a normal phenomenon after hepatitis B vaccination;
3(HBeAg- hepatitis B virus E antigen) is a sign of virus replication. Persistent positive for more than 3 months tends to be chronic;
4(HBeAb- hepatitis B virus E antibody) is the stop sign of virus replication. Virus replication is reduced, and its infectivity is weak, but it is not completely non-infectious;
5(HBcAb- hepatitis B virus core antibody) is a sign of being infected or being infected. The core antibody IGM is a sign of recent infection or virus replication, and the core antibody IgG will be produced after infection, which is of certain significance to assist the two-and-a-half examination.
Another index of pre-S 1 antigen triple virus replication has little clinical significance.
Because the core antigen is not easy to be detected in blood, there are not enough kits at present, and there are two and a half antigens and antibodies left, which is often called "hepatitis B two and a half" test or "hepatitis B five" test.
The following are the clinical significance of hepatitis B virus serum markers (commonly known as hepatitis B five or two and a half):
Clinical significance of serial number HBsAg HBsAb HBeAg HBeAb HBcAb
9 common patterns
1- I have never been infected with HBV before and now.
No anti-HBs was detected in 2-+( 1) previous infection; (2) HBsAg has disappeared and anti -HBs has not appeared in the recovery period; (3) asymptomatic HBsAg carrier.
3-++( 1) has been infected with HBV；; Before; (2) recovery period of acute HBV infection; (3) A few specimens are still infectious. ①HBV infection has passed; ② Window period before anti -HBs appears.
4-+-( 1) immunized with hepatitis B vaccine; (2) previous infection; ③ False positive.
Rehabilitation after 5-+++ acute HBV infection.
6+-+( 1) acute HBV infection; (2) chronic HBsAg carriers; (3) Weak infectivity.
7-+++ infection in the past, still have immunity. HBV infection, recovery period.
8+++(1) acute HBV infection tends to recover; (2) chronic HBsAg carriers; (3) Weak infectivity. Commonly known as "Xiao Sanyang".
9++-+ Acute or chronic hepatitis B infection. This indicates that HBV replication is highly contagious. Commonly known as "three suns".
16 rare patterns
10+-( 1) Early stage of acute HBV infection and incubation period of acute HBV infection; (2) Chronic HBV carriers are less contagious.
11+-(1) Chronic HBsAg carriers are easy to turn negative; (2) Acute HBV infection tends to recover.
12+-+- Early or chronic carriers of acute HBV infection are highly contagious.
13+-+(1) Acute HBV infection tends to recover; (2) chronic carriers.
14++-( 1) early subclinical HBV infection; (2) Secondary infection of different subtypes of 2)HBV.
15+-+( 1) early subclinical HBV infection; (2) Secondary infection of different subtypes of 2)HBV.
16++-subclinical or atypical infection.
17 ++ subclinical or atypical infection.
18++ Early subclinical or atypical infection. HBsAg immune complex, a new subtype of infection.
19-+-( 1) atypical acute infection; (2) In the early stage of infection before anti -HBc appeared, HBsAg titer was low and negative, or false positive.
20-+++ atypical acute infection.
2 1-++ acute HBV infection in the middle stage.
22-+-+-HBV infection has been cured.
23-++- atypical or subclinical HBV infection.
24-+++ atypical or subclinical HBV infection.
25-+- Acute HBV infection tends to recover.
Seven rare patterns
26+++① A subtype of HBsAg and a variant of anti -HBs (common); ② The process of transforming serum from HBsAg to anti -HBs (rare).
27 - + + + -
28 - + + + +
29 - - + + -
30 + - + + -
3 1 + + + - -
32 + + + + -
Liver function test indicator column table
Abbreviation symbol of legal unit of laboratory project
Total bilirubin quantitative tbil1.7-17.1μ mol/l
Direct bilirubin DBiL 0-6μmol/L
Alanine aminotransferase ALT 5-40u/L (Reitermann: 5-30 u/L)
Aspartate aminotransferase AST 5-40u/L
γ -glutamyltranspeptidase γ-GT(GMT) 5-54u/L (simple diazo reagent method: 0-40u/L) (improved p-nitroaniline method: 6-47u/L)
Lactate dehydrogenase LDH 109-300u/L (rate method)
Alkaline phosphatase AKP(ALP) 35- 125u/L (rate method) (3- 13u/L) (brinell method 1.4-4.0u/L).
Cholinesterase CHE 4.2-9.8ku/L (rate method)
Thymol turbidity test TTT 0-6 Martensite unit
Jaundice index 4-6 units
Serum total protein TP 60-80g/L.
Albumin A 35-55g/L
Globulin G 20-30g/L
The white/ball ratio is A/G 1.5 ~ 2.5: 1.
Cholesterol CHO 3. 1-5.7mmol/L
Triglyceride TG 0.23- 1.24 mmol/L
Prothrombin time PT 1 1- 14 seconds.
Prothrombin activity PTA 80- 100%
Creatinine Cr 44- 133 μ mol/L
Urea nitrogen bun1.79-7.1.4 mmol/l
Blood glucose Glu 3.89-6.11mmol/L.
Alpha fetoprotein AFP 50 μ g/L.
Immunoglobulin g IgG12.871.35g/l.
Immunoglobulin AIGA 2.35±0.34 g/L.
Immune IgM1.08 0.24 g/l
Complement 3c31.140.27g/L.
Complement 4c4553109mg/l
T lymphocyte subgroup CD3 0.56-0.76%%
CD4 0.38-0.52%
CD8 0.22-0.32%
There are many kinds of liver function, and there are more than 700 kinds of tests reflecting liver function. New tests are still under development and establishment, mainly including four categories.
① Examination reflecting liver cell injury: including serum enzymes, serum iron and so on. Detection of commonly used serum enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ACP), γ -glutamyltranspeptidase (γ-GT) and so on. Clinically, in various enzyme tests, ALT and AST can sensitively indicate the degree of hepatocyte injury, ALT is the most sensitive to acute hepatocyte injury, and AST is the most sensitive to reflect its degree. In the recovery period of acute hepatitis, although ALT is normal, γ-GT continues to increase, suggesting that hepatitis is chronic. The continuous decline of γ ~ GT in chronic hepatitis often indicates pathological activity.
② Examination reflecting the function of liver excretion: The ability of liver excretion and clearance of some endogenous (bilirubin, bile acid, etc.) was detected. ) or exogenous (dyes, drugs, etc. ) high intake, and quantitative detection of bilirubin in clinic. The total bilirubin is greater than17.1μ d/L, which is a case of jaundice. If bilirubin increases progressively with the decrease of ALT, it is called enzyme-bile separation, which indicates that the condition is aggravated and some cases turn into severe hepatitis.
③ Test to reflect the liver reserve function: Plasma protein (ALb) and prothrombin time (PT) are routine tests to reflect the liver reserve capacity by detecting the synthetic function of the liver. The decrease of ALb indicates that the synthesis ability of protein is weakened, and the extension of PT indicates that the synthesis ability of various coagulation factors is reduced.
④ Test to reflect the changes of liver stroma: Serum protein electrophoresis has basically replaced turbid reaction, and the increase of γ -globulin can evaluate the evolution and prognosis of chronic liver disease, suggesting that Cooper's cell function is decreased and endogenous or enterogenous antigens cannot be eliminated in blood circulation. In addition, the contents of hyaluronic acid, laminin, procollagen III peptide and collagen IV in serum can reflect the changes of liver endothelial cells, fat storage cells and fibroblasts, which are closely related to liver fibrosis and cirrhosis.
Trend of main test results of common liver diseases
* * * * * * * * * * * * * * Acute viral hepatitis chronic hepatitis cirrhosis primary liver cancer cholestasis.
* * * * * * * * * * * * * * * * * * * Typical mild and severe persistent active decompensation in and out of the liver.
Total bilirubin in serum =-↓↓-↓-~ ↓ ↓ ↓ Total bilirubin
Conjugated bilirubin =-~ ↓-~ ↓-~ ↓ ↓ Conjugated bilirubin
ALT、AST↑↑↑↑↑↑↑~
Adenosine deaminase ↑ ↑ ↑-~ ↑-~
Alkaline phosphatase ↑-~ ↓-~ ↓ ↓-~ ↓ ↓ Alkaline phosphatase
γ -glutamyl transpeptidase ↑-~↓-~↓-~↓ ↓ transpeptidase
Albumin-~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Gamma globulin =-~ ↓-~ ↓-
Cholesterol-left-left ~ left ↑ ↑ ↑ ↑ left ↑.
Cholesterol ester ↓-↓-~ ↓ ↓
α lipoprotein ↓↓-~↓↓-↓-~ ↓-~ ↑↓
Prothrombin time ↑-↑-↓ ~ ↓ * ↓
Bile acid ↑ ↑ ↑-~ ↑ ↑ Bile acid ↑ ↑ Bile acid
Ammonia-↑-~ ↑-~ ↑-
Four indexes of liver fibrosis:
Serum markers of liver fibrosis mainly include the following:
1.pciii (iii (type Ⅲ procollagen)): It reflects the synthesis of type Ⅲ collagen in the liver, and the serum content is consistent with the degree of liver fibrosis, which is obviously related to the serum T- globulin level. Normal value < 120 μ g/L.
2. Ⅳ-C (type Ⅳ collagen) is the main component of basement membrane, reflecting the renewal speed of basement membrane collagen. The increase of content can reflect the progress of liver fibrosis more sensitively, which is one of the early signs of liver fibrosis. Normal value < 75ug/l
3. laminin is a unique basement membrane non-collagen structural protein, which is positively correlated with the degree of liver fibrosis and portal vein pressure. Normal value < 130 μ g/ml.
4.HA (hyaluronidase), as one of the matrix components, is synthesized by interstitial cells, which can accurately and sensitively reflect the amount of fiber produced in the liver and the damage of hepatocytes. Some people think that this index can reflect the whole picture of diseased liver more comprehensively than liver biopsy. Normal value < 1 10 mg/L.
5.PLD is the key enzyme of collagen degradation, which is consistent with the active degree of liver collagen fiber proliferation, and it is a good index to reflect the progress of liver fiber. The normal value is110719.5 u/l [5] [6].
Among the above indexes of serum liver fibrosis, the commonly used combination of clinical knowledge is: PCIII+PCIV+HA+LN, which is called the four tests of liver fibrosis.
Reference value of Chinese and English names of coagulation images (APTT. PT and so on. ) detection and its clinical significance
Clinical significance of normal reference value of English abbreviation Chinese full name
The measurement of activated partial thromboplastin time of APTT is prolonged by 30-54 seconds: 1. Factor eight. Eight. Eight. Decreased plasma levels, such as hemophilia; The reduction of factor VIII can also be seen in some von Willebrand disease. 2. Factor II. ⅴ. ⅹ. Severe shortage of fibrinogen, such as liver disease, obstructive primary jaundice, intestinal bactericidal malabsorption syndrome, oral anticoagulants such as heparin, basic (no) fibrinogen, etc. 3. Fibrinolytic activity is increased, such as secondary voluntary fibrinolysis and fibrin degradation products in blood circulation, such as anti-F Ⅷ or F Ⅷ antibody and SLB.
2. Thrombotic diseases, such as myocardial infarction, unstable angina pectoris, cerebrovascular diseases, diabetes with vascular diseases, pulmonary infarction, deep vein thrombosis, pregnancy-induced hypertension and nephrotic syndrome.
Prolonged measurement of PT plasma prothrombin time 12- 18 seconds: congenital coagulation factor Ⅱ. V. seven. X deficiency, low (no) fibrinogen, DIC, primary fibrinolysis, vitamin K deficiency, liver disease, heparin. FDP and other oral anticoagulants in circulation.
PA prothrombin activity 80- 1.20% PA is the relative value index of PT, and its clinical significance is basically the same as that of PT.
PTR prothrombin time ratio of 0.95- 1.24 PTR is the ratio between the measured value of patients and the normal control value, which is commonly used in clinic.
INR international standardized ratio of 0.8- 1.5 Significance: When used to report PT, INR can directly reflect the most appropriate anticoagulant dosage, that is, it can prevent thrombosis without causing bleeding. A recent study showed that INR value of 2.5-3.5 was the most suitable anticoagulant dose.
D-Fbg fibrinogen 2.0-4.0 increased: diabetes and acidosis, atherosclerosis, malignant tumor, acute myocardial infarction, deep vein thrombosis, acute infectious diseases, acute nephritis uremia, myeloma, shock, surgery and mild hepatitis. Decrease: DIC, primary fibrinolysis, severe hepatitis, liver cirrhosis, low (no) fibrinogen, etc.
Hepatic thromboplastin test
HPT liver phospholipase test
2ml venous blood was anticoagulated with 109mmol/L sodium citrate.
The activity of HPT can accurately reflect the changes of plasma coagulation factors ⅶ, Ⅱ and ⅹ, especially when liver cells are damaged or liver function is abnormal, coagulation factor ⅶ decreases first, followed by coagulation factors Ⅱ and ⅹ, so this experiment is more sensitive to the severity and prognosis of liver disease than PT.
The normal reference value is 67.2 ~ 133.6%
Abnormal results showed that the activity decreased: it was found in oral dicoumarin anticoagulants, early acute liver failure, chronic liver injury and obstructive jaundice, and its severity was positively correlated with these factors. As an experimental monitoring index of warfarin anticoagulation therapy, this method is superior to PT test.
What is the value of "two-and-a-half hepatitis B" examination in male physical examination?
Male physical examination "two and a half pairs of hepatitis B" is also called hepatitis B five items, which respectively represent hepatitis B-related antigens and antibodies produced in vivo, and three corresponding antigens are added respectively: surface antigen (hbsag) and surface antibody (HBSAB); E antigen (hbeag), E antibody (HBeab); Core antigen (hbcag), core antibody (hbcab). Because the core antigen hbcag is not easy to detect, only surface antigen antibody and E antigen antibody are usually checked, so it is commonly known as "two halves of hepatitis B". "Two halves of hepatitis B" is a common indicator for doctors to judge whether there is hepatitis B virus infection and the severity of infection. These five different combinations represent different meanings, which is more comprehensive than simply checking the surface antigen ("Australian antibody") to judge hepatitis B.
Treatment measures of semi-positive hepatitis B
In the past, some manifestations of hepatitis B virus infection did not need drug treatment, mainly including:
(1) Hepatitis B virus surface antibody is single positive. This is one of the most significant positive indicators of hepatitis B "two and a half". It is a protective antibody against hepatitis B virus. The purpose of normal people's hepatitis B vaccine is to make the body produce hepatitis B virus surface antibodies.
(2) Hepatitis B virus surface antibody, E antibody and core antibody were positive at the same time; Or hepatitis B virus surface antibody and core antibody are positive; Or hepatitis B virus E antibody and core antibody are positive; Or only hepatitis B virus core antibody 1 is positive. All the above four situations can appear on the laboratory sheet. If the patient's liver function has been normal without any discomfort, it can only show that he was infected by hepatitis B virus in the past. For these hepatitis B virus infected people, there is no need to take medicine at all. They are not infected or have fully recovered. Generally speaking, they can live and work normally without hepatitis B vaccine.
Some manifestations of hepatitis B virus infection can be treated with drugs, but the types of drugs vary widely and must vary from person to person. Mainly includes:
(1) Hepatitis B virus surface antigen, E antigen and core antibody are positive at the same time, which is called "Big Three Positive", indicating that hepatitis B virus is active in replication and highly contagious. It is necessary to treat hepatitis B virus E antigen with antiviral drugs to make it negative, that is, from "big three yang" to "small three yang". If the patient's "big three yang" is accompanied by elevated transaminase, liver cirrhosis is inactive, and there is no family history of liver disease, interferon can be used for treatment. Lamivudine is more widely used than interferon, such as active hepatitis and liver cirrhosis. , but the patient's age is better than 16 years old.
(2) Hepatitis B virus surface antigen, E antibody and core antibody are positive at the same time, which is called "Little Three Positive"; Or hepatitis B virus surface antigen and core antibody are positive at the same time, which is called "Xiao Yang Er". This situation should be treated differently: A. Hepatitis B is a "small three-yang" or "small two-yang", with normal liver function and negative HBV DNA test, indicating that the degree of virus replication has been reduced or significantly reduced, indicating that the condition has improved and the infectivity has decreased. At this time, just take some liver-protecting drugs orally, such as Huganjin tablets, Luofu Jianganling and Compound Yiganling. If you don't take medicine, you can also closely observe and follow up. B. Although it is "Small Three Yang" or "Small Two Yang", the DNA of hepatitis B virus is positive and the liver function is always abnormal. This negative change is caused by the variation of hepatitis B virus, indicating that the condition tends to be complicated or aggravated, and active treatment is still needed. The therapeutic drugs can be Chinese medicinal preparations, such as Luofu Jianganling, oxymatrine, etc. You can also try lamivudine.
What needs to be pointed out in particular is that at present, the commercialized diagnostic reagents for hepatitis B in China are not standardized enough, some of them are basically unstable, and there are still counterfeit and shoddy phenomena. In addition, the detection methods of some units are inaccurate. Instruments, blood samples and temperature are often objective factors, which may lead to false positives and false negatives. The results of two units in the same blood sample are contradictory. Therefore, when you get a "two and a half" positive report, you should first treat it calmly, ask a specialist to help you analyze and judge, and go to a specialist hospital for review and verification at nine o'clock.
Adding new indicators for hepatitis B examination
It used to be "two and a half", but later an HB-cAb-Igm (core antibody Igm) was added to form three pairs. Now there is Pre-S 1 (hepatitis B virus pre-S 1 antigen, abbreviated as S 1 antigen), and "two and a half" has become "three and a half".
The significance of pre-S 1 antigen detection of hepatitis B virus mainly includes three aspects: first, early diagnosis of hepatitis B virus infection; Second, it is helpful to judge the condition of patients with hepatitis B; The third is to help patients make drug selection and prognosis judgment. The purpose of "two-and-a-half" examination is to diagnose the patient's infection, virus replication, prognosis of the course of disease and observe the curative effect of drugs. The detection of pre-S 1 antigen can make up for and strengthen the deficiency of "two and a half" detection from five aspects:
1. Because pre-S 1 antigen appears at the earliest stage of acute hepatitis B infection, it can be detected before the elevation of transaminase, so it can be used as an index for early diagnosis of hepatitis B virus infection.
2. The earlier the pre-s1antigen turns negative, the better the prognosis, which is the earliest sign of virus clearance. On the contrary, the persistent positive pre-S 1 antigen indicates that the infection will develop into chronic hepatitis.
3. Anti-HBe(+) chronic hepatitis B accounts for about 30-50% of chronic hepatitis B, and the pre-detection antigen S 1 is positive, suggesting that the virus continues to replicate in the body, and such patients are more likely to evolve into cirrhosis or liver cancer. Before the investigation, S 1 antigen made up for the difficulties in diagnosis and treatment caused by HBeAg deficiency.
4. Among asymptomatic carriers of HBV (hepatotropic DNA virus), there are a certain proportion of anti -HBe(+) patients. Before supplementary examination, the antigen S 1 can reflect that the virus is still active in vivo, suggesting that the virus has not been eliminated and there is still the possibility of potential pathological damage to the liver.
5. Antiviral treatment of hepatitis B, combined with S 1 antigen detected in early stage, can be used as pre-treatment patient screening (indication) and post-treatment curative effect judgment, especially for chronic hepatitis B patients with anti-HBe(+), which can play an important role. Foreign literature reports that interferon is not suitable for pre-C mutation. )
Therefore, the detection of S 1 antigen is very important for the diagnosis and treatment of acute hepatitis, chronic hepatitis and asymptomatic HBV carriers, as well as the antiviral treatment of hepatitis B.