血清HBsAg、HBcrAg和HBV DNA预测慢性乙型肝炎肝脏病理状态的评价  

Evaluation of serum HBs Ag, HBcr Ag and HBV DNA in prediction of the pathological status of liver in patients with chronic hepatitis 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,上海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,上海201508 [4]上海市公共卫生临床中心病理科,上海201508

出　　处：《中华实验和临床感染病杂志（电子版）》2016年第2期173-178,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：上海市卫生和计划生育委员会重点科研项目(No.20134032);国家"十二五"传染病科技重大专项(No.2013ZX10002005)

摘　　要：目的评价血清乙型肝炎病毒表面抗原(HBs Ag)、乙型肝炎病毒核心相关抗原(HBcr Ag)和乙型肝炎病毒DNA(HBV DNA)预测慢性乙型肝炎(CHB)患者肝脏不同病理学分级和分期的有效性。方法共选取CHB患者211例,其中HBe Ag阳性和阴性分别为125例和86例。血清HBs Ag、HBe Ag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、HBcr Ag和HBV DNA与肝脏病理学分级和分期均呈显著负相关(P均<0.05);HBe Ag阴性患者,血清HBcr Ag和HBV DNA与肝脏病理学分级和分期均呈显著正相关(P均<0.01)。Bayes逐步判别分析显示,HBe Ag阳性患者,仅血清HBs Ag符合判别肝脏不同病理学分级和分期的方程纳入自变量的标准(F>3.84),Fisher判别函数预测肝脏病理学分级G1、G3和分期S1、S4的正确率分别为62.7%、58.8%和63.8%、69.6%;HBe Ag阴性患者,血清HBV DNA和HBcr Ag分别符合判别肝脏不同病理学分级和分期的方程纳入自变量的标准(F>3.84),Fisher判别函数预测肝脏病理学分级G1、G3和分期S1、S4的正确率分别为79.3%、66.7%和71.7%、75.0%。结论血清HBs Ag对HBe Ag阳性患者以及血清HBV DNA和HBcr Ag分别对HBe Ag阴性患者的肝脏病理学分级G1、G3和分期S1、S4有显著的预测意义。Objective To evaluate the efficacy of serum hepatitis B surface antigen（HBs Ag）, hepatitis B core-related antigen（HBcr Ag） and hepatitis B virus DNA（HBV DNA） in predicting the pathological grading and staging of liver in patients with chronic hepatitis B（CHB）. Methods Total of 211 patients with CHB, including 125 cases with HBe Ag-positive and 86 cases with HBe Ag-negative, were enrolled. The levels of serum HBs Ag, HBcr Ag and HBV DNA were measured by chemiluminescence microparticle immunoassay, chemiluminescence enzyme immunoassay and real time fluorescent quantitative PCR, respectively. Results In HBe Ag-positive patients, all the serum HBs Ag, HBcr Ag and HBV DNA were significantly negatively correlated to the pathological grading and staging of liver（P all〈 0.05）; in HBe Ag-negative patients, both serum HBcr Ag and HBV DNA were significantly positively correlated to the pathological grading and staging of liver（P all 〈 0.01）. Bayes stepwise discriminant analyses showed that, in HBe Ag-positive patients, only serum HBs Ag conformed to the entry standard of independent variable of the equation（F 〉 3.84） discriminating different pathological grading and staging of liver, and the concordance rates of the Fisher discriminant functions to predict pathological grading G1, G3 and staging S1, S4 were 62.7%, 58.8% and 63.8%, 69.6%, respectively; in HBe Ag-negative patients, serum HBV DNA and HBcr Ag respectively conformed to the entry standard of independent variable of the equation（F 〉 3.84） discriminating different pathological grading and staging of liver, and the concordance rates of the Fisher discriminant functions to predict pathological grading G1, G3 and staging S1, S4 were 79.3%, 66.7% and 71.7%, 75.0%, respectively. Conclusions Serum HBs Ag in HBe Ag-positive patients was significant to predict pathological grading G1, G3 and staging S1, S4 of liver; and serum HBV DNA and HBcr Ag in HBe Ag-negative patients respectively was significant to predict pathological grading

关 键 词：表面抗原 肝炎 乙型 核心相关抗原 肝炎 乙型 DNA 肝炎病毒 乙型 肝炎 慢性 乙型 Bayes判别分析 病理学分级 病理学分期 

分 类 号：R512.62[医药卫生—内科学]