Objective To investigate the value of serum hepatitis B virus core-related antigens (HBcrAg) and linearized hepatitis B surface antigen (HBsAg) in diagnosis of occult hepatitis B virus infection (OBI) in Chinese population.Methods HBcrAg and linearized HBsAg levels were measured by chemiluminescence enzyme immunoassay (CLEIA) in 63 patients with OBI (OBI group) and 150 healthy people (control group).The serum HBV DNA was detected by fluorescence quantitative PCR.Receiver operating characteristics (ROC) was analyzed to calculate diagnostic accuracy of HBcrAg and combination with linearized HBsAg.Results Serum HBcrAg and linearized HBsAg were detected in 90.5％ and 42.9％ of the OBI group,and 10.7％,6.0％ of the control group,respectively (x2 =125.5,42.9,all P ＜ 0.05).There were positive correlation between HBV DNA and HBcrAg,HBV DNA and linearized HBsAg,HBcrAg and linearized HBsAg,respectively (R2 =0.471 4,0.122 2,0.086 8,P ＜ 0.05 or P ＜ 0.01).HBcrAg had better area under the ROC curves (AUC) [0.911 (95％ CI:0.864-0.946)] than linearized HBsAg [0.683 (95％ CI:0.616-0.745),Z=6.134,P ＜ 0.05].The AUC of combined detection was 0.895 (95％ CI:0.846-0.933),and no significant improvement was found (Z =0.657,P ＞ 0.05).The optimal HBcrAg and linearized HBsAg cutoff values were 100 U/mL and 0.48 IU/mL,respectively.The sensitivity of HBcrAg in diagnosis of OBI was significantly higher than that of linearized HBsAg (x2 =121.4,P ＜ 0.01),while specificity was a little lower (x2 =3.034,P ＞ 0.05).Combined detection in diagnosis of OBI did not show any improvement than single detection of HBcrAg or linearized HBsAg in sensitivity or specificity (x2 =1.322,3.802,all P ＞ 0.05).Conclusion There is a good correlation between serum HBcrAg and HBV DNA,and HBcrAg is more sensitive than linearized HBsAg or combined detection in diagnosis of OBI,which can be used as a good serological marker for the diagnosis of OBI.%目的 探讨血清乙肝病毒核心相关抗原(HBcrAg)及线性化乙型肝炎病毒表面抗原(HBsAg)对隐匿性乙型肝炎(OBI)的诊断价值.方法 选择OBI患者63例(OBI组)、体检健康者150例(对照组),采用化学发光酶联免疫分析法检测两组血清HBcrAg、线性化HBsAg,采用荧光定量PCR法检测血清HBV DNA.采用受试者工作特征(ROC)曲线分析HBcrAg、线性化HBsAg二者单独及联合检测对OBI的诊断效能.结果 OBI组和对照组血清HBcrAg阳性率分别为90.5％和10.7％,线性化HBsAg阳性率分别为42.9％和6.0％,两组比较差异均有统计学意义(x2分别为125.5、42.9,P均＜0.05).相关分析显示,HBV DNA与HBcrAg、HBV DNA、线性化HBsAg均呈正相关(R2分别为0.471 4、0.122 2、0.086 8,P＜0.05或＜0.01).ROC曲线分析显示,血清HBcrAg、线性化HBsAg诊断OBI的曲线下面积(AUC)分别为0.911(95％ CI为0.864～ 0.946)、0.683(95％ CI为0.616～ 0.745),二者联合检测诊断OBI的AUC为0.895(95％ CI为0.846～0.933),血清HBcrAg对OBI的诊断效能显著优于线性化HBsAg(Z=6.134,P＜0.05),二者联合检测并不能提高其对OBI的诊断效能(Z =0.657,P＞0.05).当血清HBcrAg、线性化HBsAg的最佳临界值分别为100 U/mL、0.48 IU/mL时,血清HBcrAg诊断OBI的敏感性显著高于线性化HB-sAg(x2=121.4,P＜0.05),特异性稍低于线性化HBsAg(x2=3.034,P＞0.05),二者联合检测诊断OBI的敏感性和特异性较单独检测HBcrAg并未明显提高(x2分别为1.322、3.802,P均＞0.05).结论 血清HBcrAg与HBV DNA存在良好的相关性,对OBI的诊断效能优于线性化HBsAg,但联合检测HBcrAg、线性化HBsAg并不能提高其诊断效能;血清HBcrAg可单独作为诊断OBI的血清学指标.
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