目的 探讨HBsAg水平在慢性HBV感染者疾病进展监测中的临床价值.方法 收集2011年5月-2015年12月在安徽医科大学第二附属医院门诊及住院时未进行抗病毒治疗的1107例不同临床阶段的慢性HBV感染者的临床资料,并根据疾病状态分为HBeAg阳性慢性乙型肝炎组(HBeAg阳性CHB组,n=356)、HBeAg阴性慢性乙型肝炎组(HBeAg阴性CHB组,n=264)、乙型肝炎肝硬化代偿期组(LC-C组,n=116)、乙型肝炎肝硬化失代偿期组(LC-D组,n=201)、原发性肝癌组(PLC组,n=170),比较不同临床阶段患者之间HBsAg表达水平的差异及HBsAg水平与临床特征的相关性.计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验;两组间比较采用T检验.计数资料组间比较采用x2检验.相关性分析采用Pearson检验.结果 HBeAg阳性CHB组、HBeAg阴性CHB组、LC-C组、LC-D组、PLC组之间患者血清HBsAg、HBV DNA水平比较,差异均有统计学意义(F值分别为100.45、86.26,P值均＜0.001).502例HBeAg阳性患者的HBsAg、HBV DNA水平均高于605例HBeAg阴性患者(t值分别为16.67、16.22,P值均＜0.001).HBeAg阳性值均CHB、LC-C、LC-D和PLC 4组间HBsAg和HBV DNA水平差异均有统计学意义(F值分别为42.92、27.38,P值均＜0.001);HBeAg阴性的CHB、LC-C、LC-D和PLC 4组间的HBsAg和HBV DNA水平差异亦均有统计学意义(F值分别为6.04、4.10,P值均＜0.05).不同HBsAg水平(＜1000 IU/ml、1000 ～20 000 IU/ml、＞20 000 IU/ml)患者间HBV DNA水平差异有统计学意义(F=189.51,P＜0.001).HBeAg阳性CHB组、HBeAg阴性CHB组、LC-C组、LC-D组患者血清HBsAg水平与HBV DNA水平均呈正相关(r值分别为0.554、0.501、0.320、0.432,P值均＜0.001).结论 HBsAg定量水平随疾病进展而逐步降低,且HBsAg与HBV DNA水平密切相关,动态监测HBsAg变化有助于发现HBV感染后疾病进展情况.%Objective To investigate the clinical value of HBsAg level in dynamic monitoring of disease progression in patients with chronic HBV infection.Methods A retrospective analysis was performed for the clinical data of 1107 patients with different clinical stages of chronic HBV infection who had not received antiviral therapy at the time of hospitalization in The Second Affiliated Hospital of Anhui Medical University from May 2011 to December 2015,and according to the disease status,they were divided into HBeAg-positive chronic hepatitis B (CHB) group(n =356),HBeAg-negative CHB group(n =264),compensated liver cirrhosis group (LC-C group,n =116),decompensated liver cirrhosis group (LC-D group,n =201),and primary liver cancer (PLC) group (n =170).These groups were compared in terms of HBsAg expression and the association between HBsAg and clinical features.An analysis of variance was used for comparison of continuous data between mnuhiple groups,and the least significant difference t-test was used for further comparison between any two groups;the t-test was used for comparison of continuous data between two groups.The chi-square test was used for comparison of categorical data between these groups.Pearson correlation analysis was also performed.Results There were significant differences in serum HBsAg and HBV DNA level between the HBeAg-positive CHB group,HBeAg-negative CHB group,LC-C group,LC-D group,and PLC group (F =100.45 and 86.26,both P ＜ 0.001).The HBeAg-positive CHB group(n =502) had significantly higher levels of HBsAg and HBV DNA than the HBeAg-negative CHB group (n =605) (t =16.67 and 16.22,both P ＜ 0.001).There were significant differences in HBsAg and HBV DNA levels between the HBeAg-positive CHB group,LC-C group,LC-D group,and PLC group (F =42.92 and 27.38,both P ＜0.001),as well as between the HBeAg-negative CHB group,LC-C group,LC-D group,and PLC group (F =6.04 and 4.10,both P ＜0.05).HBV DNA level was significantly different across patients with different HBsAg levels (＜ 1000 IU/ml,1000-20 000 IU/ml,and ＞ 20 000 IU/ml) (F =189.51,P ＜ 0.001).In the HBeAg-positive CHB group,HBeAg-negative CHB group,LC-C group,and LC -D group,serum HBsAg level was positively correlated with HBV DNA level (r =0.554,0.501,0.320,and 0.432,all P ＜ 0.001).Conclusion HBsAg level gradually decreases with disease progression and is closely associated with HBV DNA level.Dynanic monitoring of HBsAg level helps to evaluate disease progression after HBV infection.
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