慢性乙型肝炎血清HBcAg与肝细胞内HBsAg、HBcAg表达的关系及临床意义

The Relationship and Clinical Significance Between Serum HBcAg and Expression of HbsAg and HBcAg of Hepatocytes in Patients with Chronic Hepatitis B

【目的】探讨慢性乙型肝炎患者血清HBcAg与肝细胞内HBsAg、HBcAg表达的关系及临床意义。【方法】血清中HBcAg检测方法系RIA法。同时行肝组织活检，对肝组织进行炎症活动度分级（G）和纤维化程度分期（S），并采用免疫组织化学技术观察肝细胞内HBsAg、HBcAg表达。【结果】437例患者血清HBcAg阳性率为86．72％（379／437），肝细胞内HBsAg和HBcAg阳性表达率分别为93．82％（410／437）和65．45％（286／437）。血清HBcAg／抗-HBc（-／＋）分别与HBcAg／抗-HBc（＋／＋）和HBcAg／抗-HBc（-／-）组比较，肝细胞内HBcAg阳性表达率分别为52％（26／50）、66．5％（252／379）、100％（8／8），经比较差异有显著性。HBcAg／抗-HBc（＋／＋）、HBcAg／抗-HBc（-／＋）、HBcAg／抗-HBc（-／-）组肝细胞内HBsAg阳性表达率分别为94．2％（357／379）、90％（45／50）和100％（8／8）。在G1、G2，G3和G4组中血清HBcAg阳性率分别为75．4％（52／69），83．2％（119／143）、91．3％（136／149）和94．7％（357／379），G1、G2分别与G3、G4组比较差异有显著性（P〈0．05-0．005）。在S1、S2，S3和S4组中血清HBcAg阳性率分别为76．2％、87．3％、93．6％和90．0％，S1与S2、S3、S4组比较差异有显著性（P〈0．025-0．005）。【结论】结果提示，HBcAg／抗-HBc（-／＋）组肝细胞内HBsAg、HBcAg表达阳性率低。随着HBcAg阳性率的增加，肝脏的炎症和纤维化程度均加重。血清中HBcAg与肝细胞内HBsAg、HBcAg的表达，与肝脏的炎症和纤维化程度相关，可作为抗病毒治疗期间观察血清转换的一个指标。

[Objective]To study the relationship and clinical significance between serum HBcAg and expression of HBsAg and HBcAg of hepatocytes in patients with chronic hepatitis B. [Methods]RIA was used to detect serum HBcAg. Liver biopsy was conducted simultaneously to determine the inflammation grade and fibrosis stage of the liver tissues. Furthermore pathological diagnosis was performed using liver biopsy to assay the expression of HBsAg and HBcAg in bepatocytes by an immunohistochemical staining technique. [Results]The positive expression rate of HBcAg in hepatocytes showed respectively statistic difference between HBcAg/anti-HBc （-/=） and HBcAg/anti-HBc （＋/＋） and HBcAg/ anti-HBc （-/-）. The positive Expression rates of HBsAg in hepatocytes in HBcAg/ antiHBc （＋/＋）.HBcAg/ anti-HBc （-/＋）.HBcAg/ anti-HBc （-/-） were 94.2%（357/379）,90%（45/50） and 100%（8/8） respectively. Serum HBcAg positive rates in G1, G2, G3, and G4 were 75.4%,83.2%,91.3% and 94. 7%, respectively with statistic difference between G1. G2 and G3, G4（ P〈0. 05〈0. 005）. Serum HBcAg positive rate in S1, S2,S3, and S4 were 76.2% ,87. 3% ,93.6% and 90.0%, respectively with statistic difference between S1 and S2,S3,S4（ P〈0. 025-0. 005）. Serum HBcAg positive rate in 437 CHB patients was 86. 72%. The positive expression rate of HBsAg and HBcAg in hepatocytes was 93.82% and 65.90% respectively. [Conclusion] The positive expression rate of HBsAg and HBcAg in HBcAg/anti-HBc （-/＋） group in hepatocytes is low. The hepatic activity index and hepatic fibrosis increase as serum HBcAg positive rate increases. There is obvious correlation between serum HBcAg, the inflammation grade and fibrosis stage of the liver tissues and expression of HBsAg and HBcAg in hepatocytes. Serum HBcAg may be a marker of HBV active replication during antiviral therapy .