慢性乙型肝炎患者乙型肝炎病毒核心抗体与肝脏炎症程度的相关性分析  

Correlation between hepatitis B virus core antibody and liver inflammation in patients with chronic hepatitis B

作　　者：曾艳丽 魏君锋 宋晨馨 马梦阳 侯环荣 尚佳 康谊 ZENG Yan li;WEI Jun-feng;SONG Chen xin;MA Meng-yang;HOU Huan-rong;SHANG Jia;KANG Yi(Department of Infectious Diseases, Henan Provincial People＇s Hospital, People＇s Hospital of Zhengzhou University, Zhengzhou 450003, Chin)

机构地区：[1]郑州大学人民医院河南省人民医院感染科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2018年第7期642-645,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金青年科学基金(81401706);中国肝炎防治基金会-天晴肝病研究基金资助课题(TQGB20150138)

摘　　要：目的探讨初诊慢性乙型肝炎(chronic hepatitis B,CHB)患者血清乙型肝炎病毒核心抗体(hepatitis B core antibody,HBcAb)水平与肝脏炎症程度间的关系。方法初诊CHB患者436例,分别采用雅培I2000和M2000试剂检测血清乙型肝炎病毒表面抗原(hepatitis B surface antigen,HBsAg)、乙型肝炎病毒E抗原(hepatitis Be antigen,HBeAg)、HBcAb水平及乙型肝炎病毒(hepatitis B virus,HBV)-DNA,依据肝穿刺活检组织病理对患者肝脏炎症程度进行G分级;Spearman法分析血清HBcAb水平与血清学指标的相关性;logistic回归分析血清HBcAb水平对肝脏炎症G分级的影响;ROC曲线评估血清HBcAb诊断中重度肝脏炎症(G_(2-4))的效能。结果 CHB患者血清HBcAb水平随肝脏炎症程度G分级G_(0-1)级[(10.33±2.16)S/CO]、G_2级[(11.01±1.95)S/CO]、G_3级[(11.57±1.51)S/CO]、G_4级[(11.85±2.21)S/CO]逐渐升高(P<0.05);187例HBeAg阳性患者中,G_(0-1)级[(8.95±2.72)S/CO]、G_2级[(10.35±2.08)S/CO]、G_3级[(11.53±1.65)S/CO]患者血清HBcAb水平逐渐升高(P<0.05);249例HBeAg阴性患者中,G_(0-1)级[(11.13±1.23)S/CO]、G_2级[(11.45±1.75)S/CO]、G_3级[(11.64±1.19)S/CO]及G_4级[(11.85±2.21)S/CO]患者血清HBcAb水平比较差异无统计学意义(P>0.05);Spearman相关性分析结果显示,血清HBcAb水平与HBeAg阳性患者G分级呈正相关(r=0.414,P<0.001)、与HBsAg水平呈负相关(r=-0.440,P<0.001),HBcAb水平与HBeAg阴性患者G分级无线性相关(r=0.096,P=0.136);多因素logistic回归分析结果显示,高血清HBcAb是HBeAg阳性患者发生中重度肝脏炎症的危险因素(OR=1.392,95%CI:1.190~1.627,P<0.001),其对HBeAg阴性患者肝脏炎症程度G分级无明显影响(OR=1.311,95%CI:0.933~1.843,P=0.083);ROC曲线分析结果显示,血清HBcAb以10.11S/CO为最佳截断值,诊断中重度肝脏炎症的AUC为0.72(95%CI:0.639~0.799,P<0.001),灵敏度为75.6%,特异度为56.4%。结论血清HBcAb水平与HBeAg阳性初诊CHB患者肝脏炎症程度明显相关,其水平升高是HBeAg阳性CHB�Objective To explore the correlation between serum hepatitis B core antibody（HBcAb）level and liver inflammation degree in patients initially diagnosed chronic hepatitis B（CHB）.Methods A total of 436CHB patients with initially diagnosed CHB were detected the levels of hepatitis B surface antigen（HBsAg）,hepatitis Be antigen（HBeAg）and HBcAb and hepatits B virus（HBV）DNA by I2000and M2000of Abbott.The liver inflammation degree was classified by G grading according to the biopsy and pathological diagnosis of liver tissue.Spearman correlation method was used to analyze the correlation between serum HBcAb level and serological indexes.Logistic regression method was used to analyze the influence of serum HBcAb level on G grading of liver inflammation.ROC curve was used to evaluate the efficacy of HBcAb on diagnosing moderate and severe liver inflammation（GP2-4）.Results The serum HBcAb level gradually increased from liver inflammation GP〈0-1 grade（（10.33±2.16）S/CO）to GP2 grade（（11.01±1.95）S/CO）,GP3 grade（（11.57±1.51）S/CO）and GP4 grade（（11.85±2.21）S/CO）（P〈0.05）.In 187patients with HBeAg positive,the level of serum HBcAb increased from GP〈（0-1）grade（（8.95±2.72）S/CO）to GP2grade（（10.35±2.08）S/CO）and GP3 grade（（11.53±1.65）S/CO）gradually（P〈0.05）.In 249patients with HBeAg negative,there were no significant differences in the serum HBcAb levels among GP〈0-1 grade（（11.13±1.23）S/CO）,GP2 grade（（11.45±1.75）S/CO）,GP〈3 grade（（11.64±1.19）S/CO）and GP4 grade（（11.85±2.21）S/CO）（P〉0.05）.Spearman correlation showed that the HBcAb level was positively correlated with liver inflammation G grading in HBeAg positive patients（r=0.414,P〈0.001）,negatively correlated with HBsAg（r=-0.440,P〈0.001）,and not linearly correlated with liver inflammation G grading in patients with HBeAg negative（r=0.096,P=0.136）.Multivariate logistic regression analysis showed that the high level of HBcAb was

关 键 词：慢性乙型肝炎 乙型肝炎病毒核心抗体 肝脏炎症程度G分级 肝活检术 乙型肝炎病毒E抗原 

分 类 号：R512.62[医药卫生—内科学]