血清病毒学标记物预测慢性乙型肝炎肝组织病理状态的评价  

Serum viral markers in prediction of pathological status of liver tissue in patients with chronic hepatitis B

作　　者：张占卿[1] 陆伟[1] 翁齐铖 张智勇 王雁冰[1] 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]日本富士瑞必欧株式会社上海代表处,上海200336 [3]上海市公共卫生临床中心病理科,上海201508

出　　处：《同济大学学报（医学版）》2015年第4期57-63,共7页Journal of Tongji University(Medical Science)

基　　金：国家"十二五"重大科技专项(2013ZX10002005);上海市卫生和计划生育委员会科研项目(20134032)

摘　　要：目的评价血清病毒学标记物预测慢性乙型肝炎(CHB)肝组织病理状态的有效性。方法 CHB患者211例,其中HBe Ag阳性和阴性患者分别为125例和86例。血清HBs Ag、HBe Ag、抗-HBc和HBcr Ag分别采用化学发光微粒子免疫法和化学发光酶免疫法检测,血清HBV DNA采用实时荧光定量PCR检测。结果 HBe Ag阳性患者,血清HBs Ag、HBe Ag、HBcr Ag、HBV DNA与病理学分级和分期均呈显著负相关(P<0.05);血清抗-HBc与病理学分级和分期均呈显著正相关(P<0.05);HBe Ag阴性患者,血清HBs Ag、抗-HBc与病理学分级和分期无显著相关性(P>0.05);血清HBcr Ag、HBV DNA与病理学分级和分期均呈显著正相关(P<0.01)。有序logistic回归分析显示,HBe Ag阳性患者,血清HBs Ag预测病理学分级和HBs Ag、HBe Ag预测病理学分期的偏回归系数有统计学意义(P<0.05);HBe Ag阴性患者,血清HBcr Ag和HBV DNA预测病理学分级和分期的偏回归系数均有统计学意义(P<0.05)。结论血清HBs Ag和血清HBs Ag、HBe Ag分别有预测HBe Ag阳性患者肝组织病理学分级和分期的价值,血清HBcr Ag和HBV DNA均有预测HBe Ag阴性患者肝组织病理学分级和分期的意义。Objective To assess the application of serum viral markers in prediction of pathological status of liver tissue in patients with chronic hepatitis B. Methods Two hundred and eleven patients with chronic hepatitis B, including 125 HBeAg-positive and 86 HBeAg-negative patients, were enrolled in present study. Serum HBsAg, HBeAg, anti-HBc and HBcrAg were measured by chemilu-minescence microparticle immunoassay and chemiluminescence enzyme immunoassay, respectively; HBV DNA was assayed by Real Time fluorescent quantitative PCR. Results In HBeAg-positive patients, serum HBsAg, HBeAg, HBcrAg and HBV DNA were significantly correlated negatively with the pathological grading and staging of liver tissue （ P 〈 0. 05 ）, and serum anti-HBc was significantly correlated positively with the pathological grading and staging of liver tissue （ P 〈 0. 05 ）. in HBeAg- negative patients, serum HBsAg and anti-HBc were not correlated with the pathological grading and staging of liver tissue （P 〉 0. 05 ）, however, serum HBcrAg and HBV DNA were significantly correlated positively with the pathological grading and staging of liver tissue （P 〈 0. 01 ）. Ordinal logistic regression analyses showed that in HBeAg-positive patients the partial regression coefficients of serum HBsAg in predicting the pathological grading and serum HBsAg, HBeAg in predicting the pathological staging of liver tissue had statistical significance （P 〈 0. 05 ） ; in HBeAg-negative patients, the partial regression coefficients of serum HBcrAg and HBV DNA in predicting both the pathological grading and staging of liver tissue had statistical significance （P 〈 0. 05 ）. Conclusion Serum HBsAg and HBsAg, HBeAg in HBeAg-positive patients have predictive value to the pathological grading and staging, and serum HBcrAg and HBV DNA in HBeAg-negative patients have predictive significance to the pathological grading and staging of liver tissue.

关 键 词：乙型肝炎表面抗原 乙型肝炎核心抗体 乙型肝炎核心相关抗原 乙型肝炎病毒DNA 慢性乙型肝 炎 有序logistic回归 无创诊断 

分 类 号：R575.2[医药卫生—消化系统]