血清HBsAg和HBV DNA对慢性乙型肝炎肝组织病理状态的判别评价  

Appraisement of serum HBsAg and HBV DNA for discrimination of pathological status of liver tissues in patients with 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,201508 [2]上海市公共卫生临床中心检验科,201508 [3]上海市公共卫生临床中心病理科,201508

出　　处：《中华临床医师杂志（电子版）》2013年第15期50-55,共6页Chinese Journal of Clinicians(Electronic Edition)

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：目的构建基于血清HBsAg水平、HBV DNA载量、HBsAg/HBV DNA比值判别慢性乙型肝炎肝组织不同病理学分级和分期的Fisher判别函数,评价Fisher判别函数判别肝组织不同病理学分级和分期的效能。方法 472例经肝组织活检的慢性乙型肝炎患者入选本研究,其中HBeAg阳性279例,HBeAg阴性193例。血清HBsAg采用Abbott Architect I2000及其配套试剂检测,血清HBV DNA采用实时荧光定量PCR检测。统计分析采用SPSS 13.0软件。结果 HBeAg阳性患者血清HBsAg、HBV DNA与病理学分级和分期呈显著负相关(P<0.05);血清HBsAg/HBV DNA与病理学分级呈显著负相关(P<0.01),与病理学分期无显著相关性(P>0.05)。HBeAg阴性患者血清HBsAg与病理学分级和分期均无显著相关性(P>0.05),血清HBV DNA、HBsAg/HBV DNA分别与病理学分级和分期呈显著正相关和负相关(P<0.01)。根据Bayes逐步判别分析,HBeAg阳性和阴性患者符合判别不同病理学分级的模型纳入自变量标准的指标分别只有血清HBsAg和HBsAg/HBV DNA,符合判别不同病理学分期的模型纳入自变量标准的指标分别有血清HBsAg、HBV DNA和HBV DNA。判别HBeAg阳性患者不同病理学分级的Fisher判别函数判别G1、G2、G3的一致率分别为5.8%、51.1%、59.1%,判别HBeAg阴性患者不同病理学分级的Fisher判别函数判别G1、G2、G3的一致率分别为95.5%、0.0%、5.7%;判别HBeAg阳性患者不同病理学分期的Fisher判别函数判别S1、S2、S3、S4的一致率分别为36.4%、34.9%、21.6%、57.9%,判别HBeAg阴性患者不同病理学分期的Fisher判别函数判别S1、S2、S3、S4的一致率分别为86.7%、29.4%、0.0%、0.0%。结论基于血清HBsAg和基于血清HBsAg、HBV DNA的Fisher判别函数分别对HBeAg阳性患者肝组织病理学分级G3和分期S4有重要的判别价值;基于HBsAg/HBV DNA比值和基于血清HBV DNA的Fisher判别函数对HBeAg阴性患者肝组织病理学分级G1和分期S1有重要的判别价值。Objective To build the Fisher discriminant functions based on serum HBsAg levels, HBV DNA loads and HBsAg/HBV DNA ratios for discrimination of different pathological grading and staging of liver tissues in patients with hepatitis B, and to appraise the efficacy of the Fisher discriminant functions for discrimination of different pathological grading and staging of liver tissues. Methods 472 consecutive patients with chronic hepatitis B with pathological diagnoses of liver tissues, including 279 HBeAg-positive and 193 HBeAg-negative patients, were enrolled in present study. Serum HBsAg and HBeAg were determined by Abbott Architect I2000 and auxiliary reagents, serum HBV DNA was determined by real-time fluorescence quantitative PCR. SPSS 13. 0 software was used for statistical analyses.Results In HBeAg-positive patients, serum HBsAg level and HBV DNA load were negatively correlated significantly with pathological grading and staging（P＆lt;0.05）,＆amp;nbsp;serum HBsAg/HBV DNA ratio was negatively correlated significantly with pathological grading（P＆lt;0.01） and not correlated significantly with pathological staging（P＆gt;0.05）. In HBeAg-negative patients, serum HBsAg level was not correlated significantly with pathological grading and staging（P＆gt;0.05）, serum HBV DNA load was positively and HBsAg/HBV DNA ratio was negatively correlated significantly with pathological grading and staging（P＆lt;0.01）. According to the Bayes stepwise discriminant analyses, only serum HBsAg in HBeAg-positive patients and only serum HBsAg/HBV DNA ratio in HBeAg-negative patients conformed to the entry criteria of the independents of the models for discrimination of different pathological grading, and serum HBsAg and HBsAg/HBV DNA ratio in HBeAg-positive patients and only serum HBV DNA in HBeAg-negative patients conformed to the entry criteria of the independents of the models for discrimination of different pathological staging. The correctly classified rates of the original grouped cases by the Fisher discri

关 键 词：肝炎表面抗原 乙型 肝炎病毒 乙型 肝炎 乙型 慢性 肝硬化 Bayes判别分析 无创诊断 

分 类 号：R512.62[医药卫生—内科学]