慢性乙型肝炎患者肝组织中HBV抗原表达特征及其临床意义

Expressive features of HBsAg and HBcAg in the livers of chronic hepatitis B and its clinical significance

目的 探讨慢性乙型病毒性肝炎肝活检组织中检测乙肝表面抗原（HBsAg）和乙肝核心抗原（HBcAg）表达强度及表达方式的必要性。方法 采用EnVision免疫组织化学法检测196例慢性乙型肝炎患者肝穿组织中HBsAg和HBcAg的表达水平，并用荧光定量PCR检测其血清中的HBV DNA的含量。对肝组织进行炎症活动度分级和纤维化分期。结果 肝组织中的HBsAg表达强度和表达方式与炎症分级、纤维化分期和血清乙肝病毒载量均无相关性（P〉0．05）。HBcAg表达强度与炎症分级无相关性（r=-0．02，P〉0．05）；与纤维化分期呈负相关（r=-0．28，P〈0．01）；与血清乙肝病毒载量呈正相关（r=0．53，P〈0．01）。HBcAg表达方式与炎症分级为负相关（r=-0．27，P〈0．01），其中浆型组炎症活动度分级高于核型组和混合型组（P〈0．01），混合型组高于核型组（P〈0．01）。HBcAg表达方式与纤维化分期亦呈较弱的负相关（r=-0．23，P〈0．01）。其中浆型组纤维化分期高于核型组和混合型组（P〈0．05）。HBcAg表达方式与血清乙肝病毒载量呈正相关（r=0．22，P〈0．01）。结论 区分肝组织中的HBsAg表达强度和表达方式无益于了解慢性乙型肝炎患者肝损害的程度，而检测肝组织中的HBcAg则有助于临床抗病毒治疗。

Objective To investigate the necessity of detecting on the expressive intensity and pattern of HBsAg and HBcAg in the livers of chronic hepatitis B. Methods HBsAg and HBcAg were detected in paraffinembedded liver tissue by EnVision immunohistochemistry. Serum hepatitis B virus DNA（HBV DNA） was tested by real-time quantitative polymerase chain reaction. The degrees of hepatic inflammatory activity （grade） and fibrosis （stage） of liver biopsies were determined according to the standard of the Chinese progamme of prevention and treatment of viral hepatitis. Results The expression of HBsAg was not correlated with the grade, the stage and the levels of serum HBV DNA（ P 〉 0.05）. Liver HBcAg expressive intensity was not correlated with the grade （ r = - 0.02, P 〉 0.05 ）, while negatively correlated with the stage （ r = - 0.28, P 〈 0.01 ） and positively correlated with the serum HBV DNA levels （ r = 0.53, P 〈 0.01 ）. Liver HBcAg expressive pattern was negatively correlated with the grade （r= -0.27, P 〈 0.01 ）. The grade in cytoplasmic pattern group was higher than in nuclear pattern group and in mixed pattern group （ P 〈 0.01 ）, and that in mixed pattern group was higher in nuclear pattern group （P 〈 0.01 ）. Liver HBcAg expressive pattern was negatively correlated with the stage （ r = - 0.23, P 〈 0.01 ）. The stage in cytoplasmic pattern group was higher than in nuclear pattern group and in mixed pattern group （ P 〈 0.05 ）. Liver HBcAg expressive pattern was positively correlated with the levels of serum HBV DNA （ r = 0.22, P 〈 0.01 ）. Conclusion Distinguishing the expressive intensity and pattern of HBsAg and HBcAg in the liver of chronic hepatitis B may not help understand the degree of hepatic lesion. The detection of HBcAg in liver tissue of CHB may be beneficial for the antiviral therapy.