血清HBcrAg在慢性乙型肝炎病毒感染自然史中的变化  

Changes of serum hepatitis B core-related antigen in the natural history of chronic hepatitis B virus infection

作　　者：陆伟[1] 王雁冰[1] 张占卿[1] 黄丹[1] 李秀芬[1] 周新兰[1] 丁荣蓉[1] 曾东[2] 冯艳玲[2] LU Wei;WANG Yanbing;ZHANG Zhanqing;HUANG Dan;LI Xiufen;ZHOU Xinlan;DING Rongrong;ZENG Dong;FENG Yanling(Department of Hepatobiliary Medicine,Shanghai Public Health Clinical Center of Fudan University, Shanghai 201508, China;Department of Clinical Pathology,Shanghai Public Health Clinical Center of Fudan University, Shanghai 201508, China)

机构地区：[1]上海市公共卫生临床中心肝胆内科,上海201508 [2]上海市公共卫生临床中心病理科,上海201508

出　　处：《胃肠病学和肝病学杂志》2019年第9期983-989,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家“十二五”传染病科技重大专项(2013ZX10002005);上海市卫计委重点科研项目(20134032)

摘　　要：目的探讨血清乙型肝炎核心相关抗原(HBcrAg)在慢性乙型肝炎病毒(HBV)感染自然史中的演化,评价血清HBcrAg对活动期的预测性能。方法慢性HBV感染患者492例入选本研究。血清HBcrAg和HBsAg分别采用化学发光酶免疫法和化学发光微粒子免疫法检测,HBV DNA采用实时荧光定量PCR检测。结果 HBeAg阳性患者,非活动期和活动期血清HBcrAg、HBsAg和HBV DNA的中位值(四分位距)分别为5.502(5.201~5.668)log10 kU/ml和4.810(3.789~5.459)log10 kU/ml,4.735(4.489~4.978)log10 IU/ml和3.945(3.428~4.573)log10 IU/ml,>7.699(7.655~>7.699)log10 IU/ml和7.407(6.240~>7.699)log10 IU/ml;血清HBcrAg、HBsAg和HBV DNA预测活动期的ROC曲线下面积(95%CI)分别为0.738(0.683~0.787)、0.812(0.762~0.855)和0.717(0.662~0.768)。HBeAg阴性患者,非活动期和活动期血清HBcrAg、HBsAg和HBV DNA的中位值(四分位距)分别为<0.000(<0.000~0.394)log10kU/ml和2.163(1.045~2.879)log10 kU/ml,3.098(1.993~3.612)log10 IU/ml和3.221(2.821~3.655)log10 IU/ml,<2.699(<2.699~3.3178)log10 IU/ml和5.535(4.326~6.253)log10 IU/ml;血清HBcrAg、HBsAg和HBV DNA预测活动期的ROC曲线下面积(95%CI)分别为0.887(0.834~0.927)、0.581(0.509~0.650)和0.978(0.946~0.993)。结论血清HBcrAg、HBsAg和HBV DNA在HBeAg阳性和阴性慢性HBV感染活动期分别表现为进行性差异化下降和上升;无论HBeAg阳性或阴性,血清HBcrAg对活动期的预测效能均介于血清HBsAg和HBV DNA之间。Objective To investigate the evolution of serum hepatitis B core-related antigen(HBcrAg) in the natural history of chronic HBV infection, and to evaluate the predictive performance of serum HBcrAg for the active phases of hepatitis.Methods 492 patients with chronic HBV infection were enrolled in this study. Serum HBcrAg and HBsAg were detected by chemiluminescence immunoassay and chemiluminescence microparticle immunoassay respectively, HBV DNA was detected by real-time fluorescence quantitative PCR.Results In the non-active and active phase of hepatitis of HBeAg-positive patients, the medians(Interquartile ranges) of serum HBcrAg, HBsAg and HBV DNA were 5.502(5.201-5.668)log10 kU/ml and 4.810(3.789-5.459) log10 kU/ml, 4.735(4.489-4.978)log10 IU/ml and 3.945(3.428-4.573) log10 IU/ml and >7.699(7.655->7.699)log10 IU/ml and 7.407(6.240->7.699) log10 IU/ml, respectively;the areas under ROC curves(95% CI) of serum HBcrAg, HBsAg and HBV DNA in predicting the active phase of hepatitis were 0.738(0.683-0.787), 0.812(0.762-0.855) and 0.717(0.662-0.768), respectively. In the non-active and active phase of hepatitis of HBeAg-positive patients, the medians(Interquartile ranges) of serum HBcrAg, HBsAg and HBV DNA were <0.000(<0.000-0.394)log10 kU/ml and 2.163(1.045-2.879) log10 kU/ml, 3.098(1.993-3.612)log10 IU/ml and 3.221(2.821-3.655) log10 IU/ml and <2.699(<2.699-3.3178)log10 IU/ml and 5.535(4.326-6.253) log10 IU/ml, respectively. The areas under ROC curves(95% CI) of serum HBcrAg, HBsAg and HBV DNA in predicting the active phase of hepatitis were 0.887(0.834-0.927), 0.581(0.509-0.650) and 0.978(0.946-0.993), respectively.Conclusion Serum HBcrAg,HBsAg and HBV DNA in the active phase of hepatitis of HBeAg-positive and-negative chronic HBV infection show a progressive differentiated fall and differentiated rise, respectively. In both HBeAg positive and negative patients, the efficacies of serum HBcrAg in predicting the active phases of hepatitis are between serum HBsAg and HBV DNA.

关 键 词：乙型肝炎核心相关抗原 乙型肝炎病毒 慢性乙型肝炎 自然史 病毒学指标 

分 类 号：R575[医药卫生—消化系统]