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中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (03) : 172 -175. doi: 10.3877/cma.j.issn.1674-6880.2017.03.006

所属专题: 文献

论著

慢性乙型肝炎及肝硬化患者乙型肝炎表面抗原及乙型肝炎病毒DNA定量检测的临床意义
孙丹凤1, 陆许贞1,(), 谢新生1, 王柯尹1   
  1. 1. 314000 浙江嘉兴,浙江省嘉兴市第一医院感染科
  • 收稿日期:2017-02-24 出版日期:2017-06-01
  • 通信作者: 陆许贞
  • 基金资助:
    嘉兴市科技局项目(2016BY28006); 嘉兴市重点学科感染性疾病学项目(04-Z-14)

Clinical significance of surface antigen of hepatitis B virus and hepatitis B virus DNA quantitative testing in patients with chronic hepatitis B and liver cirrhosis

Danfeng Sun1, Xuzhen Lu1,(), Xinsheng Xie1, Keyin Wang1   

  1. 1. Department of Infectious Disease, the First Hospital of Jiaxing City, Jiaxing 314000, China
  • Received:2017-02-24 Published:2017-06-01
  • Corresponding author: Xuzhen Lu
  • About author:
    Corresponding author: Lu Xuzhen, Email: lxz1972214@163.com
引用本文:

孙丹凤, 陆许贞, 谢新生, 王柯尹. 慢性乙型肝炎及肝硬化患者乙型肝炎表面抗原及乙型肝炎病毒DNA定量检测的临床意义[J/OL]. 中华危重症医学杂志(电子版), 2017, 10(03): 172-175.

Danfeng Sun, Xuzhen Lu, Xinsheng Xie, Keyin Wang. Clinical significance of surface antigen of hepatitis B virus and hepatitis B virus DNA quantitative testing in patients with chronic hepatitis B and liver cirrhosis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(03): 172-175.

目的

探讨慢性乙型肝炎(CHB)及其肝硬化患者乙肝表面抗原(HBsAg)和乙肝病毒(HBV)DNA定量检测的临床意义。

方法

将152例诊断为CHB的患者根据肝脏病变严重程度分为慢性乙型活动性肝炎组(A组,74例)、代偿期肝硬化组(B组,39例)及失代偿期肝硬化组(C组,39例)。对三组患者间血清HBsAg、HBV DNA定量水平进行比较,采用Pearson相关分析对HBsAg与HBV DNA定量进行检验,采用Spearman相关分析对HbsAg、HBV DNA定量水平分别与肝病等级进行分析。

结果

A、B、C组患者间HBsAg定量[(3.9 ± 0.5)、(3.2 ± 0.3)、(2.7 ± 0.6)lgIU/mL]及HBV DNA[(7.3 ± 1.2)、(6.1 ± 1.4)、(5.3 ± 1.4)lgIU/mL]定量水平比较,差异均有统计学意义(F = 75.564、30.384,P均< 0.05),进一步两两比较发现,B组与C组HbsAg及HBV DNA定量水平均显著低于A组,且C组更低(P均< 0.05)。Pearson相关分析发现,所有患者HBsAg与HBV DNA定量水平之间呈正相关(r = 0.614,P < 0.001),HBsAg与HBV DNA定量水平在A组呈正相关(r = 0.570,P < 0.001),而在B组与C组中无相关性(r = 0.267,P = 0.101;r = 0.232,P = 0.155)。Spearman相关分析提示,HbsAg及HBV DNA定量水平均与肝病等级呈负相关(r = -0.741,P < 0.001;r = -0.583,P < 0.001)。

结论

肝硬化程度越重,其HBsAg、HBV DNA水平越低,HBsAg定量测定结合HBV DNA定量结果可以更好地反映肝细胞内乙型肝炎病毒的复制及疾病的进展情况。

Objective

To explore the clinical significance of surface antigen of hepatitis B virus (HBsAg) and hepatitis B virus (HBV) DNA quantitative testing in patients with chronic hepatitis B (CHB) and liver cirrhosis.

Methods

Totally 152 CHB patients were divided into CHB with non-cirrhosis patients (group A, 74 cases), compensated cirrhosis patients (group B, 39 cases) and decompensated cirrhosis patients (group C, 39 cases). The serum HBsAg levels and HBV DNA loads were compared among the three groups. Pearson correlation analysis was used to investigate the correlation between HBsAg and HBV DNA. The relationship between severity of liver disease and HBsAg levels or HBV DNA were assessed by Spearman correlation analysis.

Results

The serum HBsAg levels [(3.9 ± 0.5), (3.2 ± 0.3), (2.7 ± 0.6) lgIU/mL] and HBV DNA loads [(7.3 ± 1.2), (6.1 ± 1.4), (5.3 ± 1.4) lgIU/mL] all showed significant differences among the three groups (F = 75.564, 30.384, all P < 0.05), and HBsAg levels and HBV DNA in group B and group C were much lower than those in group A, and were lowest in group C (all P < 0.05). Positive correlations were found between serum HBsAg and HBV DNA levels in all patients (r = 0.614, P < 0.001) and also in group A (r = 0.570, P < 0.001), but not in group B (r = 0.267, P = 0.101) or group C (r = 0.232, P = 0.155). Meanwhile, HBsAg levels and HBV DNA loads were negative correlated with the severity of liver cirrhosis (r = -0.741, P < 0.001; r = -0.583, P < 0.001).

Conclusion

The heavier the liver cirrhosis, the lower the HBsAg and HBV DNA levels, HBsAg levels combined with HBV DNA loads can better reflect the replication of HBV and progression of CHB.

表1 三组慢性乙型肝炎患者间HBsAg与HBV DNA定量水平的比较(lgIU/mL, ± s
1
中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015更新版)[J]. 中华肝脏病杂志,2015,21(12):219-240.
2
Brown RS Jr, McMahon BJ, Lok AS, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: a systematic review and meta-analysis[J]. Hepatology, 2016, 63 (1): 319-333.
3
Liu J, Fan D. Hepatitis B in China[J]. Lancet, 2007, 369 (9573): 1582-1583.
4
Martinot-Peignoux M, Asselah T, Marcellin P. HBsAg quantification to predict natural history and treatment outcome in chronic hepatitis B patients[J]. Clin Liver Dis, 2013, 17 (3): 399-412.
5
杨娜,胡雪梅. HBeAg阳性慢性乙肝患者HBsAg定量与HBeAg、HBV DNA、基因型的相关性[J]. 临床输血与检验,2016,18(1):43-46.
6
朱淑敏,魏从真,马进,等. 慢性乙肝患者血清甲状腺激素水平与HBsAg的关系及意义[J]. 山东医药,2016,56(24):59-60.
7
Larsson SB, Eilard A, Malmstrom S, et al. HBsAg quantification for identification of liver disease in chronic hepatitis B virus carriers[J]. Liver Int, 2014, 34 (7): e238-e245.
8
Locamini S, Bowden S. Hepatitis B surface antigen quantification not what it seems on the surface[J]. Hepatology, 2012, 56 (2): 411-414.
9
Manesis EK, Papatheodoridis GV, Tiniakos DG, et al. Hepatitis B surface antigen: relation to hepatitis B replication parameters in HBeAg-negative chronic hepatitis B[J]. J Hepatol, 2011, 55 (1): 61-68.
10
Chan HL, Wong VW, Tse AM, et al. Serum hepatitis B surface antigen quantitation can reflect hepatitis B virus in the liver and predict treatment response[J]. Clin Gastroenterol Hepatol, 2007, 5 (12): 1462-1468.
11
裴彦祯,韩涛,马晓艳,等. HBsAg及HBV DNA定量水平在慢性乙型肝炎、肝硬化和肝癌患者中的变化[J]. 中华肝脏病杂志,2011,19(10):743-746.
12
Wong DK, Yuen MF, Poon RT, et al. Quantification of hepatitis B virus covalently closed circular DNA in patients with hepatocellular carcinoma[J]. J Hepatol, 2006, 45 (4): 553-559.
13
黄绍萍,卢水华,王介非,等. 聚乙二醇干扰素α-2a治疗慢性乙型病毒性肝炎HBsAg转阴影响因素分析[J]. 中国实用内科杂志,2009,29(11):1044-1045.
14
Wu ZB, Cao H, Liu T, et al. Dynamic expression profile of HBsAg according to hepatic parenchyma cells′ volume at different liver fibrosis stages in the immune clearance phase[J]. Zhonghua Gan Zang Bing Za Zhi, 2012, 20 (10): 742-745.
15
余雪平,郭如意,柯绍鹏,等. 慢性乙型肝炎及其肝硬化患者HBsAg及HBV DNA定量变化及其相关性[J]. 南方医科大学学报,2015,35(5):682-686.
16
李莉,秦小超,陈凯. HBV血清学标记物与HBV-DNA定量检测相关分析的临床价值[J]. 检验医学与临床,2013,10(16):2143-2144.
17
洪江,刘娟. 慢性乙肝合并肝硬化患者血清谷丙转氨酶、乙肝表面抗原水平与肝功能的相关性[J]. 上海医药,2015,36(7):47-49.
18
Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B[J]. Hepatology, 2016, 63 (1): 261-283.
19
Zheng XY, Wei RB, Tang L, et al. Meta-analysis of combined therapy for adult hepatitis B virus-associated glomerulonephritis[J]. World J Gastroenterol, 2012, 18 (8): 821-832.
20
蔡文品,赵春,吴惠洁,等. 慢性乙型肝炎患者血清HBV DNA水平与肝纤维化指标的相关性[J]. 实用医学杂志,2009,25(1):72-73.
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