慢性乙型肝炎及其肝硬化患者HBsAg与HBV DNA定量变化及其相关性  

Changes in HBsAg titer and HBV DNA load and their correlation in patients with chronic hepatitis B and HBV-related liver cirrhosis

作　　者：余雪平[1] 郭如意[1] 柯邵鹏[1] 黄清流[1] 林成祖[1] 林志鹏[1] 陈素梅[1] 李菊兰[1] 杨鹏雅[1] 苏智军[1] 

机构地区：[1]福建医科大学附属泉州第一医院感染科,福建泉州362000

出　　处：《南方医科大学学报》2015年第5期682-686,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(81400625);福建省卫生厅青年研究课题(2013-1-45);泉州市科技计划项目资助课题;泉州市卫生局资助课题(2012Z11)~~

摘　　要：目的探讨慢性乙型肝炎(CHB)、乙型肝炎肝硬化(HBV-LC)患者HBs Ag定量和HBVDNA定量的变化及两者的相关性。方法采集46例CHB轻中度患者(CHB-LM组),24例CHB重度患者(CHB-S组)和28例HBV-LC患者入院时及51例患者经核苷(酸)类似物(NA)抗病毒治疗4.08±3.06月时的血清标本;采用化学发光法定量检测HBs Ag水平,荧光PCR定量检测HBVDNA载量。多组比较采用Kruskal-Wallis,两组间比较采用Mann-Whitney U检验,治疗前后比较采用Wilcoxon检测,相关性分析采用Spearman检验。结果 HBs Ag和HBVDNA定量在CHB-LM组、CHB-S组和HBV-LC组中逐渐下降(χ2=12.537和8.381,P=0.002和0.015);CHB-LM组和CHB-S组HBs Ag和HBV DNA定量值均高于HBV-LC组(P<0.05);CHB-LM和CHB-S两组之间差异均无统计学意义(Z=-0.649和0.032,P>0.05)。HBe Ag阳性患者HBs Ag和HBVDNA定量在CHB-LM组、CHB-S组和HBV-LC组中呈下降趋势(χ2=6.146,P=0.046和1.009,P>0.05);CHB-LM组HBs Ag定量高于HBV-LC组(Z=-2.247,P=0.025)。HBe Ag阴性患者HBs Ag和HBVDNA定量在CHB-LM组、CHB-S组和HBV-LC组中逐渐下降(χ2=7.196和14.658,P<0.05);CHB-LM组和CHB-S组HBs Ag和HBV DNA定量均高于HBV-LC组(P<0.01)。HBs Ag与HBVDNA定量水平在CHBLM组(r=0.389,P=0.009)、HBV-LC组(r=0.431,P=0.022)中均呈正相关性;而在CHB-S组中无相关性(r=0.348,P=0.104)。与NA抗病毒治疗前相比,51例患者治疗后HBs Ag水平略有下降(Z=-1.050,P=0.294),而HBVDNA水平明显下降(Z=-5.415,P<0.001);治疗后HBs Ag定量与HBVDNA定量无统计学相关性(r=0.241,P=0.111);且两者治疗前后的差值也无统计学相关性(r=0.257,P=0.085)。结论 HBs Ag和HBVDNA定量在CHB-LM、CHB-S和HBV-LC患者中逐渐降低,按照HBe Ag阳性和阴性分组后,这种趋势依然存在;HBs Ag和HBVDNA之间呈正相关,但并非绝对平行。Objective To explore the changes in HBsAg titer and HBV DNA load and their correlation in patients with chronic hepatitis B （CHB） and HBV-related liver cirrhosis （HBV-LC）. Methods Forty-six patients with mild to moderate CHB （CHB-LM）, 24 patients with severe CHB （CHB-S）, and 28 patients with HBV-LC at admission, and 51 patients with HBV-LC at 4.08± 3.06 months during antiviral treatment were tested for serum HBsAg titer and HBV DNA load using Abbott chemiluminescence and fluorescence quantitative PCR, respectively. Results The serum HBsAg titer and HBV DNA load gradually decreased with increased disease severity （from CHB-LM, CHB-S to HBV-LC;χ2=12.537 and 8.381, respectively, P0.05）. Among HBeAg-positive patients, HBsAg titer and HBV DNA load tended to decrease with increased disease severity （from CHB-LM, CHB-S to HBV-LC;χ2=6.146, P=0.046 andχ2=1.017, P〉0.05;respectively）, and CHB-LM group had significantly higher HBsAg titer than HBV-LC group （Z=-2.247, P=0.025）. Among the HBeAg-negative patients, serum HBsAg and HBV DNA load gradually declined with the disease severity （χ2=8.660 and 13.581, respectively, P〈0.05）, and were obviously higher in CHB-LM and CHB-S groups than in HBV-LC group （P〈0.05）. Positive correlations were found between serum HBsAg and HBV DNA levels in CHB-LM （r=0.389, P=0.009） and HBV-LC groups （r=0.431, P=0.022）, but not in CHB-S group （r=0.348, P=0.104）. After antiviral therapy, the serum HBsAg titer was slightly decreased （Z=-1.050, P=0.294） while HBV DNA load markedly reduced （Z=-5.415, P〈0.001）, showing no correlation between them （r=0.241, P=0.111） or between the measurements before and after treatment （r=0.257, P=0.085）. Conclusion Serum HBsAg titer and HBV DNA load decreases progressively from CHB-LM to CHB-S and HBV-LC in both HBeAg- positive and-negative patients. The serum HBsAg titer is positively correlated with HBV DNA load, but their levels are not consistently parallel.

关 键 词：HBSAG HBVDNA 肝炎 乙型 慢性 肝硬化 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]