慢性乙型肝炎病毒携带者抗病毒治疗的无创性筛选指标探讨

Establishing non-invasive prediction indices for chronic HBV carders

目的建立HBV携带者是否需要抗病毒治疗的无创性预测指标。方法对139例入院临床诊断为HBV携带者的患者进行肝活组织检查，按病理学诊断G≥2或S≥3者17例（12．2％），视为需要抗病毒治疗组，122例为G〈2且S〈3者，视为不需要抗病毒治疗组。按以上分组标准把可能与其有关的因素如年龄、性别、病程、是否有乙型肝炎家族史、HBeAg是否阳性、HBeAg定量、层黏连蛋白、Ⅲ型前胶原、透明质酸、Ⅳ型胶原蛋白、γ球蛋白、白细胞低于正常下限、脾脏面积和HBV DNA载量代入Logistic回归方程（后退法，极大似然法）进行分析，对筛选出来的影响因素采用Roe曲线方法确定诊断临界值。结果非条件Logistic回归分析显示，仅Ⅲ型前胶原与HBV携带者是否需要抗病毒治疗密切相关，其OR值为1．122，其他指标均与慢性HBV感染者是否需要抗病毒治疗无关。Ⅲ型前胶原诊断界值为85．02、100．79、105．50ng／ml时，其灵敏度分别为80．0％、67．3％、54．8％，特异度分别为52．0％、70．6％、84．20／0；曲线下面积为70．8％。结论Ⅲ型前胶原可作为HBV携带者的患者是否需要抗病毒治疗的参考指标，但肝活组织检查仍是不可替代的标准。

Objective To establish non-invasive predictors of antiviral therapy for chronic HBV carriers. Methods Liver biopsies were performed in 139 chronic HBV carriers. Seventeen of them were histopathologically graded as G≥ 2 or S ≥ 3, being considered in need of antiviral therapy. The other 122 subjects with grades G 〈 2 and S 〈 3 were not applicable for antiviral therapy. Independent predictors were analyzed using logistic regression （Backward）. The covariates included age, gender, duration of HBV infection, family history of hepatitis B, HBeAg positivity, quantitive HBeAg, level of LN, PCⅢ, HA, CIV and gammaglobin, low white blood cell count, spleen measument and HBV load. ROC curve was used to define the diagnostic critical value. Results Logistic regression analysis showed that PCⅢ, but not other factors, was related to antiviral therapy in these HBV carriers （OR = 1.122）. When the diagnostic critical value was 85.02 ng/ml, 100.79 ng/ml and 105.50 ng/ml, its sensitivity was 80.0%, 67.3% and 54.8%, respectively; its specificity was 52.0%, 70.6% and 84.2%, respectively. The area under ROC curve was 70.8%. Conclusion PCⅢ might be a reference index for predicting antiviral therapy in chronic HBV carriers, but liver biopsy is still a non-substutiable reference index.