血清定量HBV标志物界定慢性HBV感染自然史分期的新评价  

Novel evaluation of serum quantitative HBV markers for delimiting natural history phases of chronic HBV infection

作　　者：李凤萍 陆伟[1] 林维佳 张占卿[1] LI Fengping;LU Wei;LIN Weijia;ZHANG Zhanqing(Department of Hepatobiliary Medicine,Shanghai Public Health Clinical Center,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

出　　处：《胃肠病学和肝病学杂志》2025年第2期157-165,共9页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家“十二五”科技重大专项(2013ZX10002005);国家“十三五”科技重大专项(2017ZX10203202)。

摘　　要：目的重新评价血清定量乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)、乙型肝炎e抗原(hepatitis B e antigen,HBeAg)、乙型肝炎e抗体(antibody against HBeAg,抗-HBe)、乙型肝炎核心抗体(antibodies against hepatitis B core antigen,抗-HBc)和乙型肝炎病毒(hepatitis B virus,HBV)DNA界定慢性HBV感染自然史分期的性能。方法本研究涉及的HBeAg阳性和阴性队列分别由245例HBeAg阳性和233例HBeAg阴性患者组成。参照Scheuer标准,HBeAg阳性和阴性病理学非显著肝炎活动(non-significant hepatitis activity,NSHA)分别定义为病理学分级≤G_(1)且分期≤S_(1)和分级≤G_(1)。根据HBV DNA预测HBeAg阳性队列病理学NSHA的反转形ROC曲线,由200例患者组成的可能HBV高复制(possibly high HBV replication,PHVR)亚队列被指定。结果HBsAg、HBeAg、抗-HBc、HBV DNA预测HBeAg阳性队列和PHVR亚队列病理学NSHA的AUC分别为0.679和0.721、0.659和0.718、0.703和0.706、0.583和0.632;HBsAg、抗-HBe、抗-HBc、HBV DNA预测HBeAg阴性队列病理学NSHA的AUC分别为0.545、0.529、0.671、0.682。ALT≤59 IU/L串联HBsAg>4.301 log_(10)IU/mL、HBeAg>2.301 log_(10)PEIU/mL预测HBeAg阳性队列病理学NSHA和分级≤G_(1)且分期≤S_(2)的正确率分别为73.9%(34/46)和95.7%(44/46)、73.9%(34/46)和93.5%(43/46);抗-HBc≤4.301 log_(10)IU/mL、HBV DNA≤3.903 log_(10)IU/mL预测HBeAg阴性队列病理学NSHA和分级≤G_(2)的正确率分别为80.0%(96/120)和92.5%(111/120)、80.5%(103/128)和92.2%(118/128)。结论ALT串联HBsAg或HBeAg可能是预测HBeAg阳性NSHA的高效参数,抗-HBc或HBV DNA可能是预测HBeAg阴性NSHA的高效参数。Objective To re-evaluate the performance of serum quantitative hepatitis B surface antigen(HBsAg),hepatitis B e antigen(HBeAg),antibody against HBeAg(anti-HBe),antibodies against hepatitis B core antigen(anti-HBc),and hepatitis B virus(HBV)DNA for delimiting the natural history phases of chronic HBV infection.Methods The HBeAg-positive and HBeAg-negative cohorts involved in this study consisted of 245 HBeAg-positive and 233 HBeAgnegative patients with chronic HBV infection,respectively.With reference to Scheuer criteria for liver pathology,HBeAg-positive and HBeAg-negative pathological non-significant hepatitis activity(NSHA)were defined as grade≤G_(1)and stage≤S_(1)and grade≤G_(1),respectively.A possibly high HBV replication(PHVR)subcohort consisting of 200 patients was designated based on the reverse shape of ROC curve for HBV DNA in predicting pathological NSHA in the HBeAg-positive cohort.Results The AUC for HBsAg,HBeAg,anti-HBc and HBV DNA in predicting pathological NSHA in the HBeAg-positive cohort and PHVR subcohort were 0.679 and 0.721,0.659 and 0.718,0.703 and 0.706,0.583 and 0.632,respectively.The AUC for HBsAg,anti-HBe,anti-HBc and HBV DNA in predicting pathological NSHA in the HBeAg-negative cohort were 0.545,0.529,0.671 and 0.682,respectively.The correct rates for ALT≤59 IU/L tandem HBsAg>4.301 log_(10)IU/mL,and tandem HBeAg>2.301 log_(10)PEIU/mL in predicting pathological NSHA and grade≤G_(1)and stage≤S_(2)in the HBeAg positive cohort were 73.9%(34/46)and 95.7%(44/46),and 73.9%(34/46)and 93.5%(43/46),respectively.The correct rates for anti-HBc≤4.301 log_(10)IU/mL,and HBV DNA≤3.903 log_(10)IU/mL in predicting pathological NSHA and grade≤G_(2)in the HBeAg-negative cohort were 80.0%(96/120)and 92.5%(111/120),80.5%(103/128)and 92.2%(118/128),respectively.Conclusion ALT tandem HBsAg or HBeAg may be valid parameters in predicting HBeAg-positive NSHA,and anti-HBc or HBV DNA alone may be valid parameters in predicting HBeAg-negative NSHA.

关 键 词：慢性乙型肝炎 自然史 乙型肝炎表面抗原 乙型肝炎E抗原 乙型肝炎核心抗体 

分 类 号：R512.6[医药卫生—内科学] R575[医药卫生—临床医学]