不同HBeAg结果HBV感染患者临床指标与肝脏病理特征的关联性分析  

Relationships between hepatic pathological changes and clinical manifestations in HBeAg positive and negative patients infected with hepatitis B virus

作　　者：樊璠 凤鸣 许雅楠 张宇 朱丽莉[1] 施晴波 徐沛峰 张建峰 FAN Fan;FENG Ming;XU Ya'nan;ZHANG Yu;ZHU Lili;SHI Qingbo;XU Peifeng;ZHANG Jianfeng(Rehabilitation Department,Affiliated Nanjing Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu 210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)康复科,江苏南京210003

出　　处：《淮海医药》2024年第1期26-31,共6页Journal of Huaihai Medicine

摘　　要：目的:探讨不同HBeAg结果乙型肝炎病毒(HBV)感染患者临床指标与肝脏病理特征的关联性。方法:选取2021年1月—2022年2月某院收治的103例乙肝病毒感染患者为研究对象,根据血清HBeAg结果将患者分为HBeAg阳性组(n=39)和HBeAg阴性组(n=64)。分析影响2组患者肝脏炎症程度和纤维化程度的危险因素,绘制ROC曲线,分析CHE水平对不同HBeAg结果的HBV感染患者肝脏炎症和纤维化程度的预测效能。结果:HBeAg阳性组年龄、ALB、CHE水平低于HBeAg阴性组,中重度炎症比例高于HBeAg阴性组,差异有统计学意义(P<0.05)。纤维化分级≥2、CHE水平降低为HBeAg阴性患者发生中重度肝炎的独立危险因素。炎症分级≥2级是HBeAg阴性患者发生中重度肝脏纤维化的独立危险因素。血清CHE水平预测HBeAg阳性患者肝组织炎症程度和纤维化程度的曲线下面积(AUC)分别为0.820和0.900,敏感度分别为83.3%和79.3%,特异度分别为71.4%和90.0%。血清CHE水平预测HBeAg阴性患者肝脏炎症程度和纤维化程度的AUC分别为0.723和0.597,敏感度分别为82.2%和29.4%,特异度分别为57.9%和100%。结论:不同HBeAg结果的HBV感染者ALB、CHE水平及炎症程度不同;炎症程度越重的HBeAg阴性患者越容易发生中重度肝纤维化,反之亦然;血清CHE水平可作为预测HBV感染者肝脏炎症和纤维化程度的敏感指标。Objective:To investigate correlations between HBV-related hepatic pathological changes and clinical biomarkers in HBeAg positive and negative patients.Methods:A total of 103 HBV-infected patients were collected as research objects,and were classified into HBeAg positive group(39 cases) and a HBeAg negative group(64 cases) according to serum HBeAg levels.The role of clinical parameters in predicting the degree of liver inflammation and fibrosis in HBeAg positive and negative patients were analyzed carefully,including the age,sex,HBV DNA,ALT,AST,ALB,CHE,TBIL,and DBIL.Results:Comparing with HBeAg positive patients,the average age of HBeAg negative patients was higher(42.88±9.40 years vs.38.31±11.02 years,P=0.027).The serum level of ALB in HBeAg negative patients was higher than that in HBeAg positive patients(45.23±5.08 g/L vs.42.22±5.28 g/L,P=0.005).The difference of serum level of CHE between the two groups was also statistically significant(8 782.91±2 625.38 U/L vs.7 199.67±2 146.57 U/L,P=0.002).HBeAg negative group had lower prevalence of moderate to severe liver inflammation than that in HBeAg positive group(29.69% vs.53.85%,P=0.015).As for HBeAg positive patients,the degree of liver inflammation was positively correlated with the serum level of ALT(r=0.514,P=0.001),negatively correlated with the serum level of ALB(r=-0.331,P=0.037)and CHE(r=-0.509,P=0.001).Also,the degree of liver fibrosis was negatively correlated with the serum level of ALB(r=-0.485,P=0.002)and CHE(r=-0.512,P=0.001).In HBeAg negative patients,the degree of liver inflammation showed positive relevance with age(r=0.28,P=0.022) and negative relevance with serum level of CHE(r=-0.337,P=0.005).Multivariate logistic regression analysis revealed that lower serum level of CHE was related to higher risk of moderate to severe liver inflammation in HBeAg negative patients(P<0.05,OR<1).Receiver operating characteristic(ROC) analysis identified that area under the curve(AUC) of CHE in predicting the level of liver inflammation in HBeAg negative pat

关 键 词：乙型肝炎病毒 HBEAG 胆碱酯酶 肝组织病理学变化 临床特征 

分 类 号：R512.62[医药卫生—内科学]