慢性乙型肝炎患者血清HBsAg水平与肝脏炎症和纤维化程度相关性研究

摘要

Objective To investigate the relation of hepatitis B surface antigen (HBsAg) level with chronic hepatitis B (CHB) and liver inflammation and fibrosis.Methods A total of 301 patients who diagnosed CHB and underwent liver biopsy were enrolled into the study.Meantimes,the biochemical markers,ferritin (FERR),serum HBsAg and HBV DNA quantitation were detected.The relation between HBsAg level and liver pathology were determined by spearman rank correlation analysis.The receiver operating characteristic curve was used to evaluate the accuracy of HBsAg level for liver inflammation and fibrosis.Results The body mass index (BMI),age,gender,genotype and family history had no effective on liver inflammation and fibrosis (P ＜ 0.05).With the progressing of inflammation and fibrosis,the serum AST and ALT raise obviously (x2 =71.193,96.344,47.847,63.981 ; P =0.000,0.000,0.000,0.000).When fibrosis reached to S4,the level of HBV DNA decreased obviously (x2 =33.322;P =0.000).With the aggravation of inflammation and fibrosis,the serum HBsAg gradually descended (x2 =68.173,15.719; P =0.000,0.000).The areas under operating characteristics curves of HBsAg predicted ≤ G3 and ≤ S3 were 0.732 and 0.793,and the specificity were 0.778,0.891,and sensitivity were 0.685,and 0.633,respectively.Conclusion The level of HBsAg of Chinese CHB patients descended gradually with the aggravation of liver inflammation and fibrosis.The serum HBsAg had a higher specificity to predict ≤ G3 and ≤ S3 of CHB patients.But there had superiority of predicting fibrosis than inflammation.%目的 探讨慢性乙型肝炎患者HBsAg水平与肝脏炎症和纤维化的关系.方法 301例确诊为慢性乙型肝炎的患者纳入研究,同时进行肝脏活检术检查和生物化学、铁蛋白、血清HBsAg、HBV DNA定量检测.Spearman等级相关分析血清HBsAg水平与肝脏炎症分级和纤维化分期间的关系；logistic回归分析法分析相关指标的诊断意义,受试者工作曲线法评价血清HBsAg水平预测肝脏炎症分级和纤维化分期的准确性.结果 体质量指数、年龄、性别、基因型和家族史对CHB患者肝脏炎症和纤维化无明显影响(P＜0.05).AST、ALT随着炎症、纤维化进展而升高,差异具有统计学意义(x2=71.193、96.344、47.847、63.981;P =0.000、0.000、0.000、0.000).纤维化为S4时,HBV DNA明显下降(x2=33.322,P=0.000).HBsAg水平随着炎症和纤维化程度加重而逐步下降(x2=68.173,15.719;P =0.000,0.000).HBsAg水平预测≤G3和≤S3的曲线下面积分别为0.732和0.793,特异度分别为0.778、0.891,灵敏度依次为0.685、0.633.结论 中国CHB患者HBsAg水平随着肝脏炎症分级和纤维化分期程度加重而逐渐下降.血清HBsAg水平对CHB患者肝脏炎症≤G3和纤维化≤S3的预测具有较高的特异性,且对纤维化的预测优于炎症.