血清乙型肝炎核心相关抗原预测慢性乙型肝炎肝组织病理状态的评价  

Evaluation of serum hepatitis B core-related antigen in prediction of the pathological status of liver tissue in patients with chroni chepatitis B

作　　者：张占卿[1] 陆伟[1] 翁齐铖 张智勇 沈芳[3] 王雁冰[1] 冯艳玲[4] 

机构地区：[1]上海市公共卫生临床中心肝炎二科,201508 [2]日本富士瑞必欧株式会社 [3]上海市公共卫生临床中心检验科,201508 [4]上海市公共卫生临床中心病理科,201508

出　　处：《肝脏》2015年第8期576-582,共7页Chinese Hepatology

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

摘　　要：目的探讨和评价血清乙型肝炎核心相关抗原(HBcrAg)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 CHB患者211例,其中HBeAg阳性和阴性患者分别为125例和86例。血清HBcrAg采用化学发光酶免疫法检测。数据处理和统计分析采用SPSS 16.0软件。结果 HBeAg阳性患者,血清HBcrAg与肝组织病理学分级和分期均呈显著负相关(r_s=-0.305,P=0.001和r_s=-0.370,P=0.000),在不同病理学分级和分期之间的差异均有统计学意义(r_s=16.756,P=0.000和r_s=25.003,P=0.000)。HBeAg阴性患者,血清HBcrAg与病理学分级和分期均呈显著正相关(r_s=0.476,P=0.000和r_s=0.556,P=0.000),在不同病理学分级和分期之间的差异均有统计学意义(r_s=22.529,P=0.000和r_s=26.416,P=0.000)。HBeAg阳性患者,血清HBcrAg预测病理学分级≥G3和分期≥S3的ROC曲线下面积分别为0.722和0.739(P=0.000和P=0.000);以血清HBcrAg≤4.81×104 kU/mL和≤8.13×104 kU/mL为标准,其预测病理学分级≥G3和分期≥S3的灵敏度、特异度、准确度分别为0.706、0.714、0.712和0.821、0.698、0.736。HBeAg阴性患者,血清HBcrAg预测病理学分级≥G2和分期≥S2的ROC曲线下面积分别为0.807和0.799(P=0.000和P=0.000);以血清HBcrAg≥40.18 kU/mL和≥10.64 kU/mL为标准,其预测病理学分级≥G2和分期≥S2的灵敏度、特异度、准确度分别为0.821、0.724、0.756和0.775、0.696、0.733。结论血清HBcrAg能有效地预测HBeAg阳性患者的肝组织严重炎症活动度和严重纤维化程度以及HBeAg阴性患者的肝组织显著炎症活动度和显著纤维化程度。Objective To appraise the efficacy of serum hepatitis B core-related antigen（HBcrAg）in prediction of the inflammatory activity and fibrotic level of liver tissue in patients with chronic hepatitis B.Methods Two hundred and eleven patients with chronic hepatitis B,including 125 hepatitis B e antigen（HbeAg）-positive and 86 HBeAg-negative patients,were enrolled in the study.Serum HBcrAg were measured by chemiluminescence enzyme immunoassay.SPSS16.0software was used for data processes and statistical analyses.Results In HBeAg-positive patients,serum HBcrAg had a significantly negative correlation with pathological grading and staging（r_s=-0.305,P=0.001 和r_s=-0.370,P=0.000）,which showed statistically significant differences in different pathological grading and staging（r_s =16.756,P=0.000 和 r_s=25.003,P=0.000）.In HBeAg-negative patients,serum HBcrAg was significantly positively correlated with pathological grading and staging（r_s=0.476,P=0.000和r_s=0.556,P=0.000）,which showed statistically significant difference in different pathological grading and staging（r_s=22.529,P=0.000和r_s=26.416,P=0.000）.In HBeAg-positive patients,the areas under the receiver operating characteristic（ROC）curve of serum HBcrAg in prediction of pathological grading≥G3 and staging ≥S3 were 0.722 and 0.739（P=0.000 and P=0.000）,respectively.The sensitivities,specificities and accuracies in prediction of pathological grading ≥G3 and staging ≥S3 were 0.706,0.714,0.712 and 0.821,0.698,0.736,respectively,when the cut-off values of serum HBcrAg were not more than 4.81×104 kU/mL and 8.13×104 kU/mL.In HBeAg-negative patients,the areas under the ROC curve of serum HBcrAg in prediction of pathological grading≥G2 and staging ≥S2 were 0.807 and 0.799（P=0.000 and P=0.000）,respectively.taking serum HBcrAg ≥40.18 kU/mL and ≥10.64 kU/mL as cut-offs,The sensitivities,specificities and accuracies in prediction of pathological grading≥G2and staging ≥S2 were 0.821,0.724,0.756 and 0.775,0.696,0.733,respe

关 键 词：慢性乙型肝炎 乙型肝炎核心相关抗原 定量检测 肝纤维化 无创诊断 

分 类 号：R512.62[医药卫生—内科学]