探讨乙型肝炎病毒前S1抗原和乙型肝炎病毒DNA的相关性及临床意义

Clinical Significance and Relevance of Hepatitis B virus PreS1 Antigen and HBV DNA

目的探讨乙型肝炎（乙肝）病毒（HBV）前S1（PreS1）抗原和HBV-DNA的相关性及其在乙肝诊断中的临床意义。方法采用酶联免疫吸附试验（ELISA）法对290例乙肝血清进行PreS1和HbsAg、HbsAb、HbeAg、HbeAb、HBcAb检测,同时对每个标本进行HBV-DNA定量分析。根据乙肝标志物的检测结果,将所测标本中HBsAg、HBeAg、HBcAb阳性90例设为A组;HBsAg、HBeAb、HBcAb阳性95例设为B组;HBsAg、HBcAb阳性65例设为C组;HBsAg阳性40例设为D组。比较各组PreS1和HBV-DNA的阳性率。结果 290例检测标本中,PreS1抗原阳性183例,阳性率63.1%,其中A组74例（82.2%）,B、C、D组分别为52例（54.7%）、45例（69.2%）、12例（30.0%）,HBeAg阳性者（A组）PreS1抗原阳性率82.2%显著高于HBeAg阴性者（B、C、D组）54.5%（P〈0.01）。HBV-DNA阳性167例,阳性率为57.6%,其中A组85例（94.4%）,B、C、D组分别为42例（44.2%）、35例（53.8%）、5例（12.5%）,HBeAg阳性者（A组）HBV-DNA阳性率94.4%显著高于HBeAg阴性者（B、C、D组）41.0%（P〈0.01）。HBV-DNA阳性患者中,HBeAg阳性85例中51例（60.0%）PreS1抗原阳性,HBeAg阴性的82例中50例（61.0%）PreS1抗原阳性,两组比较差异无统计学意义（P〉0.05）。结论血清乙肝病毒PreS1和HBV-DNA有很高的符合率,且较HBeAg更能准确反映HBV复制的情况,可同时作为监测HBV感染复制及预后的指标。

Objective To investigate diagnostic significance of Hepatitis B virus （HBV） PreS1 antigen in hepatitis B and its relevance with HBV DNA. Methods Serum PreS1,HbsAg,HbsAb,HbeAg,HbeAb and HBcAb in 290 patients with HBV were detected by enzyme-linked immunosorbent assay （ELISA） method,and the HBV-DNA quantitative analysis was simultaneously made in each specimen. According to the results of hepatitis B markers,patients of HBsAg,HBeAg,HBcAb positive were selected as group A （n=90 ）; of HBsAg,HBeAb,HBcAb positive as group B （n=95 ）; of HBsAg,HBcAb positive as group C （n=65 ）; and patients of HBsAg positive as group D （n=40）. HBV-DNA and PreS1 positive rate in each group were compared and analyzed. Results In the test specimens of the 290 patients,there were 183 patients （63.1%）with PreS1 positive,including 74 cases （82.2%） of group A,52 cases （54.7%） of group B,45 cases （69.2%） of group C,12 cases （30.0%） of group D. PreS1 positive rate of HBeAg positive patients（group A） was 82.2% higher than HBeAg negative patients （group B,C,D）PreS1 positive rate 54.5%（P0.01）.There were 167 patients （57.6%）with HBV-DNA positive,including 85 cases （94.4%） in group A,42 cases （44.2%） in group B,35 cases （53.8%） in group C,5 cases （12.5%） in group D. HBV-DNA positive rate of HBeAg positive patients（group A） was 94.4% higher than HBeAg negative patients （group B,C,D）HBV-DNA positive rate 41.0%（P0.01）. Among HBV-DNA positive patients,there were 85 HBeAg positive patients,including 51 patients （60.0%） of PreS1 antigen positive; 85 HBeAg negative patients,including 50 patients （60.9%） of PreS1 antigen positive. There was no significant difference between the two groups （P0.05）.Conclusion Serum HBV PreS1 protein has a high compliance rate with HBV-DNA,and it is more accurate than HBeAg in reflecting HBV replication situation,which can be used to monitor HBV infection and prognosis as indicators at the same time.