慢性HBV感染者HBsAg/HBV DNA比率的检测及其临床意义  

Detection of serum HBsAg-to-HBV DNA ratio in patients with chronic HBV infection and its clinical significance

作　　者：郑怡娟 余雪平[1] 郭如意[1] 柯邵鹏[1] 李菊兰[1] 王星[1] 何秀华[1] 林志鹏[1] 林成祖[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,泉州362000

出　　处：《中国人兽共患病学报》2016年第6期558-563,共6页Chinese Journal of Zoonoses

基　　金：国家自然科学基金(No.81400625);福建省自然科学基金(No.2015J01413);福建省卫生厅青年研究课题(No.2013-1-45);泉州市科技计划项目资助课题(No.2013Z53;2012Z11)联合资助~~

摘　　要：目的探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者HBsAg/HBV DNA比率的临床意义。方法收集46例轻中度慢性乙型肝炎(CHB-LM)患者、24例重度慢性乙型肝炎(CHB-S)患者和28例乙型肝炎肝硬化(HBV-LC)患者入院时及40例CHB患者治疗12周的外周血;采用全自动生化仪检测谷丙转氨酶(ALT)、总胆红素(TBil)等指标,化学发光法定量检测HBsAg水平,实时荧光PCR定量检测HBV DNA。结果 HBV-LC组HBsAg和HBV DNA均明显低于CHBLM(Z=-3.416和-2.636,均P<0.05)、CHB-S组(Z=-2.499和-2.407,均P<0.05),HBsAg/HBV DNA比率均稍高于CHB-LM、CHB-S组(均P>0.05);CHB-LM和CHB-S组之间比较无统计学差异(Z=-0.649、-0.032和-0.885,均P>0.05)。HBeAg阴性组的HBsAg、HBV DNA水平均高于HBeAg阳性组(Z=-2.662和-4.950,P=0.008和<0.001),HBsAg/HBV DNA比率较HBeAg阳性组明显升高(Z=-2.544,P=0.011)。治疗12周与治疗前比较,完全应答组HBsAg、HBV DNA均明显下降(Z=-2.103和-3.297,P=0.035和0.0002),HBsAg/HBV DNA比率明显升高(Z=-3.233,P=0.01);部分应答组HBV DNA明显下降(Z=-2.666,P=0.005),HBsAg/HBV DNA比率明显升高(Z=-2.666,P=0.000 4),HBsAg水平稍下降(Z=-1.600,P=0.110);无应答组HBV DNA明显下降(Z=-3.059,P=0.023),HBsAg稍下降(Z=-0.341,P=0.733),但HBsAg/HBV DNA比率升高(P>0.05)。HBsAg/HBV DNA比率与PLT(r=0.561,P=0.002)呈明显正相关。HBsAg/HBV DNA比率预测病毒学完全应答的曲线下面积AUC(0.643)高于HBsAg(0.580)和HBVDNA(0.433)。结论进展性HBV-LC和HBeAg阴性CHB患者HBsAg/HBV DNA比率偏高,且升高的HBsAg/HBV DNA比率与抗HBV治疗疗效欠佳有关。We investigated the clinical significance of serum HBsAg-to-HBV DNA ratio in patients with chronic HBV infection.Peripheral blood of 46 patients with mild to moderate chronic hepatitis B（CHB-LM）,24 patients with severe CHB（CHB-S）and 28 patients with hepatitis B virus related liver cirrhosis（HBV-LC）as well as 40 CHB patients followed up 12 weeks were collected.Alanine aminotransferase（ALT）and total bilirubin（TBil）were detected using automatic biochemical analyzer.Serum HBsAg titer and HBV DNA load were measured using the Architect QT assay and real-time fluorescence PCR,respectively.Results showed that serum HBsAg titer,HBV DNA load were significantly higher in CHB-LM and CHBS groups than that in HBV-LC group（Z=-3.416and-2.636;-2.499and-2.407;respectively,all P〈0.05）,and HBsAg-to-HBV DNA ratio in HBV-LC group was slightly higher than that in CHB-LM and CHB-S groups（all P〉0.05）.But there were no obviously difference of the three indexes between CHB-LM and CHB-S groups（Z=-0.649,-0.032and-0.885;P=0.516,0.974 and 0.376）.Serum HBsAg titer,HBV DNA load were markedly higher in HBeAg-positive group than that in HBeAg-negative group（Z=-2.662and-4.950,P=0.008and0.001;respectively）,while serum HBsAg-to-HBV DNA ratio was markedly lower in HBeAg-positive group compared with HBeAg-negative group（Z=-2.544,P=0.011）.After 12 weeks of antiviral treatment,in complete-responders group and patrial-responders group,the HBsAg titer（Z=-2.103,P=0.035）and serum HBV DNA load（Z=-3.297,-2.666;both P〈0.05）were significantly decreased,except HBsAg titer was slightly reduced（Z=-1.600,P=0.110）,while serum HBsAg-to-HBV DNA ratio was markedly increased（Z=-3.233,-2.666,both P〈0.05）.In nonresponders group,the HBV DNA load was significantly declined（Z=-3.059,P=0.002）,and HBsAg titer was slightly declined（Z=-0.341,P=0.744）,while serum HBsAg-to-HBV DNA ratio was slightly increased（Z=-0.341,P=0.733）.Serum HBsAg-to-HBV DNA ratio were markedly negatively correlated with PLT（r=0.5

关 键 词：慢性乙型肝炎 HBSAG HBV DNA HBsAg/HBV DNA比率 核苷(酸)类似物 

分 类 号：R512.6[医药卫生—内科学]