筛选血清HBV-DNA阴性且HBsAg与HBsAb阳性CHB患者的血清危险因素及评分与预后的相关性研究  

Correlation of Screening for Serum Risk Factors and Risk Factor Score to Prognosis between DNA-negative and Co-existing with HBsAg/HBsAb in CHB Patients

作　　者：杨阳 张欢妍[2] 吕幸 彭俊华 YANG Yang;ZHANG Huanyan;LÜXing;PENG Junhua(Jintan Hospital,the Affiliated Hospital of Jiangsu Vocational College of Medicine,Jiangsu Changzhou 213200,China;Department of Clinical Laboratory,the First People’s Hospital of Jintan Affiliated to Jiangsu University,Jiangsu Changzhou 213200,China)

机构地区：[1]江苏医药职业学院金坛临床学院,江苏常州213200 [2]江苏大学附属金坛第一人民医院检验科,江苏常州213200

出　　处：《现代检验医学杂志》2023年第6期153-158,共6页Journal of Modern Laboratory Medicine

基　　金：江苏医药职业学院临床教学基地科研发展专项课题(编号:20229135):基于pgRNA为指标的HBsAg阳性肿瘤患者肝损害的研究;常州市科技支撑(社会发展)计划(编号:CE20185004):参芩白术散调节2型糖尿病肠道菌群,降低胰岛素抵抗的临床研究及机理探讨。

摘　　要：目的筛选乙肝病毒(hepatitis B virus,HBV)DNA阴性的乙肝表面抗原(hepatitis B surface antigen,HBsAg)和乙肝表面抗体(hepatitis B surface antibody,HBsAb)阳性的慢性乙型肝炎(chronic hepatitis B,CHB)患者的血清危险因素,探讨危险因素评分与预后的相关性。方法筛选2020年1月~2022年6月江苏大学附属金坛第一人民医院收治的HBV-DNA阴性的CHB患者193例,其中HBsAg和HBsAb阳性的119例患者作为观察组,HBsAg阳性且HBsAb阴性的74例患者作为对照组。收集所有患者的临床资料并计算外周血炎性指标[嗜中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),血小板-淋巴细胞比值(platelet-to-lymphoccyte ratio,PLR),全身免疫炎症指数(systemic immune inflammatory index,SII)]和肝纤维化指标[谷氨酰转肽酶-血小板比值(gamma-glutamyl transpeptidase to platelet ratio,GPR),门冬氨酸转移酶纤维化指数(aspartate aminotransferase to platelet ratio index,APRI),肝纤维化4因子指数(fibrosis 4 score,FIB-4)],采用t检验和U检验比较两组间各指标的差异。采用ROC曲线评价差异指标的预测价值,多因素回归分析影响HBsAg和HBsAb阳性模式的危险因素。随访观察组患者二年内HBsAg和HBsAb变化,将20例HBsAg水平明显降低的患者作为预后良好组,24例HBsAg水平没有明显降低甚至HBsAb消失的患者作为预后不良组。结果与对照组相比,观察组的PLT水平[(181.07±63.31)×10^(9)/L vs(158.27±61.55)×10^(9)/L]和TP水平[70.20(65.73,74.90)g/L vs 67.00(64.45,71.25)g/L]明显升高,差异有统计学意义(t=2.459,U=3254.00,均P<0.05);而观察组的HBsAg水平[1.60(0.37,13.15)IU/ml vs 138.78(8.66,161.94)IU/ml]和APRI比值[0.31(0.22,0.47)vs 0.46(0.32,0.71)]明显降低,差异有统计学意义(U=1685.50,2972.00,均P<0.05)。ROC曲线确定PLT,TP,APRI和HBsAg在两组间的差异的截断值分别为157.50×10^(9)/L,69.45 g/L,0.29和22.56 IU/ml。单因素回归分析结果显示,PLT≥157.50×10^(9)/L,TP≥69.45 g/L,APRI≤Objective To screen the serum risk factors for chronic hepatitis B(CHB)patients with hepatitis B virus(HBV)DNA negative and hepatitis B surface antigen(HBsAg)/hepatitis B surface antibody(HBsAb)co-existing,and explore the correlation between risk factors score and prognosis.Methods 119 patients with HBsAg/HBsAb positive in the First People’s Hospital of Jintan Affiliated to Jiangsu University from January 2020 to June 2022 were selected as the observation group,and 74 patients with HBsAg positive and HBsAb negative were selected as the control group.Clinical data of all patients were collected and peripheral blood inflammatory indicators[neutrophil to lymphocyte ratio(NLR),platelet-to-lymphoccyte ratio(PLR),systemic immune inflammatory index(SII)]and liverfibrosis indicators[gamma-glutamyl transpeptidase to platelet ratio(GPR),aspartate aminotransferase to platelet ratio index(APRI),fibrosis 4 score(FIB-4)]were calculated.t-test and U-test were used to compare the differences between the two groups.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of difference indicators.Risk factors affecting HBsAg and HBsAb positive pattern were analyzed using multivariate regression.Based on changes in HBsAg and HBsAb levels of observation group over 2 years,20 patients were classified as having a good prognosis with a significant reduction in HBsAg levels and 24 patients as having a poor prognosis without significant reduction in HBsAg levels or even undetectable HBsAb levels.Results Compared with the control group,the levels of PLT[(181.07±63.31)×10^(9)/L vs(158.27±61.55)×10^(9)/L]and TP[70.20(65.73~74.90)g/L vs 67.00(64.45~71.25)g/L]in the observation group were increased,the differences were statistically significant(t=2.459,U=3254.00,all P<0.05).The levels of HBsAg[1.60(0.37~13.15)IU/ml vs 138.78(8.66~161.94)IU/ml]and APRI[0.31(0.22~0.47)vs 0.46(0.32~0.71)]in the obser-vation group were decreased,and the differences were statistically significant(U=1685.50,2972.00,all P<0.

关 键 词：慢性乙型肝炎 乙肝表面抗原 乙肝表面抗体 评分模型 

分 类 号：R512.62[医药卫生—内科学] R446.6[医药卫生—临床医学]