血清HBsAg和HBV DNA预测慢性乙型肝炎肝组织病理状态的评价  

Appraisement of serum HBsAg levels and HBV DNA loads for prediction of the pathological status of liver tissues in chronic hepatitis B

作　　者：张占卿[1] 陆伟[1] 王雁冰[1] 周新兰[1] 黄丹[1] 丁荣蓉[1] 沈芳[2] 冯艳玲[3] 

机构地区：[1]上海市公共卫生临床中心肝炎二科,上海201508 [2]上海市公共卫生临床中心检验科,上海201508 [3]上海市公共卫生临床中心病理科,上海201508

出　　处：《胃肠病学和肝病学杂志》2014年第5期554-559,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家"863"高技术研究发展计划生物和医药领域重大/重点基金(2006AA02A411)

摘　　要：目的 探讨血清乙型肝炎表面抗原（HBsAg）水平和乙型肝炎病毒DNA（HBV DNA）载量预测慢性乙型肝炎（CHB）肝组织炎症活动度和纤维化程度的效能.方法 472例经肝组织活检的CHB患者入选本研究,其中HBeAg阳性279例,HBeAg阴性193例.肝组织病理学分级≥G2、≥G3、≥G4分别被定义为显著炎症、严重炎症和进展期炎症,病理学分期≥S2、≥S3和≥S4分别被定义为显著纤维化、严重纤维化和进展期纤维化.结果 HBeAg阳性患者血清HBsAg在G1与G3、G2与G3、S1与S4、S2与S4、S3与S4之间的差异均有统计学意义（P均＜0.05）,血清HBV DNA载量在S1与S4、S2与S4、S3与S4之间的差异均有统计学意义（P均＜0.05）;HBeAg阴性患者血清HBsAg在肝组织不同病理学分级和分期之间的差异无统计学意义（P＞0.05）,血清HBV DNA载量在G1与G3、S1与S2、S1与S3、S1与S4之间的差异均有统计学意义（P均＜0.05）.HBeAg阳性患者血清HBsAg诊断严重炎症和进展期纤维化的ROC曲线下面积分别为0.711 （95％ CI：0.647～0.775）和0.765（95％ CI：0.707～0.823）,血清HBV DNA诊断严重炎症和进展期纤维化的ROC曲线下面积分别为0.589（95％ CI：0.519 ～0.659）和0.700（95％ CI：0.632 ～0.769）;HBeAg阴性患者血清HBV DNA诊断非显著炎症和非显著纤维化的ROC曲线下面积分别为0.644（95％ CI：0.565 ～0.723）和0.684（95％ CI：0.606～0.761）.结论 血清HBsAg对HBeAg阳性患者肝组织严重炎症和进展期纤维化有一定的预测价值;血清HBV DNA对HBeAg阳性患者肝组织严重炎症和进展期纤维化和对HBeAg阴性患者肝组织非显著炎症和非显著纤维化有一定的预测价值.Objective To explore the efficacy of serum HBsAg levels and HBV DNA loads for prediction of the inflammatory activities and fibrotic levels of liver tissues in chronic hepatitis B.Methods 472 cases of chronic hepatitis B diagnosed by liver biopsy,including 279 HBeAg-positive and 193 HBeAg-negative patients,were enrolled in the study.The pathological grading ≥ G2,≥ G3,≥ G4 and pathological staging ≥ S2,≥ S3,≥ S4 were defined as significant,severe,advanced inflammation and fibrosis,respectively.Results In HBeAg-positive patients,the differences of serum HBsAg levels in G1 and G3,G2 and G3,S1 and S4,S2 and S4,S3 and S4 had statistical significance （P ＜0.05） ; and differences of serum HBV DNA loads in S1 and S4,S2 and S4,S3 and S4 had statistical significance （P ＜0.05）.In HBeAg-negative patients,the differences of serum HBsAg levels in different pathological grading and staging had no statistical significance （P ＞ 0.05）,and differences of serum HBV DNA loads in G1 and G3,S1 and S2,S1 and S3,S1 and S4 had statistical significance （P ＜ 0.05）.In HBeAg-positive patients,the area under ROC curves of serum HBsAg for diagnosis of severe inflammation and advanced fibrosis were 0.711 （95％ CI：0.647 ～ 0.775） and 0.765（95％ CI：0.707 ～0.823）,respectively; and those of serum HBV DNA for diagnosis of severe inflammation and advanced fibrosis were 0.589 （95％ CI：0.519 ～0.659） and 0.700 （95％ CI：0.632 ～0.769）,respectively.In HBeAgnegative patients,the area under ROC curves of serum HBV DNA for diagnosis of non-significant inflammation and nonsignificant fibrosis were 0.644 （95％ CI：0.565 ～ 0.723） and 0.684 （95％ CI：0.606 ～ 0.761）,respectively.Conclusion Serum HBsAg has predictive significance for severe inflammation and advanced fibrosis of liver tissues in patients with HBeAg-positive chronic hepatitis B.Serum HBV DNA has predictive significance both for severe inflammation and advanced fibrosis of liver tissues in patients with HBeAg-positive

关 键 词：乙型肝炎表面抗原 乙型肝炎病毒DNA 定量检测 慢性乙型肝炎 病理学 肝纤维化 

分 类 号：R575.2[医药卫生—消化系统]