乙型肝炎病毒大蛋白在慢性乙型肝炎患者中检测的临床价值探讨

Clinical value of hepatitis B virus large protein in detecting patients with chronic hepatitis B

目的探讨乙型肝炎病毒表面抗原大蛋白(HBV-LP)反映HBV复制的可靠性及其检测的临床价值和意义。方法采用酶联免疫吸附试验(ELISA)检测304份慢性乙型肝炎患者血清标本的HBV-LP和乙型肝炎两对半结果,并应用实时荧光定量PCR方法平行检测HBV-DNA结果。结果 304例慢性乙型肝炎患者标本中,HBV-DNA的阳性率67.76%,HBV-LP的阳性率75.66%,两者差异无统计学意义;其中186例HBeAg阴性患者HBV-LP阳性率65.59%,高于HBV-DNA的阳性率(50.54%),差异有统计学意义(P<0.01);186例HBeAg阴性患者中,HBV-DNA和HBV-LP检出一致率为76.34%;血清中HBV-LP(OD值)与HBV-DNA拷贝数之间具有良好的相关性,相关系数(r)=0.853。结论 HBV-LP能反映出乙型肝炎病毒的复制情况;在HBeAg阴性乙型肝炎患者中,HBV-LP较HBV-DNA更能敏感反映HBV的感染复制状态;在无条件开展HBV-DNA检测的一些基层医院,HBV-LP可以作为反映乙型肝炎病毒的复制情况的一个很好的血清学指标。

OBJECTIVE To explore the reliability of hepatitis B virus large protein（HBV-LP） reflecting HBV replication and the clinical value and meaning of detection.METHODS HBV-LP and hepatitis viral marks were detected in 304 serum specimens of the patients infected with HBV by using ELISA,and HBV-DNA was detected with RT-PCR in the parallel patients.RESULTS The positive rates of HBV-DNA,HBV-LP in 304 serum specimens were 67.76% and 75.66% and there were not statistical difference（P〉0.05）;The positive rates of HBV-DNA,HBV-LP in 186 serum specimens of HBeAg-negtive patients were 65.59% and 50.54%,there were significant difference between the two group（P〈0.01）;The concordance rate was 76.34% between HBV-LP and HBV-DNA in HBeAg negtive patients;The contents of serum HBV-LP was positively correlated with the number of HBV-DNA copies,coefficient（r） =0.853,P〈0.01.CONCLUSION The level of serum HBV-LP can reflect the situation of HBV replication;HBV-LP is more sensitive than HBV-DNA in the patients with HBeAg-negative chronic hepatitis B;HBV-LP is a good serological index for reflecting HBV replication in some of the basic-level hospitals without conditional for HBV-DNA testing.