慢性乙型肝炎病毒感染者前S1抗原和抗体检测的临床意义

The clinical significance of PreS1Ag and anti-PreS1 in patients with chronic hepatitis B

目的探讨前s1抗原（PreS1Ag）与前s1抗体（抗-PreS1）在慢性HBV感染者中的检出情况及其临床意义。方法收集慢性HBV感染者428例，检测HBV血清学标志物、HBVDNA及PreS1Ag、抗-PreS1，分析PreS1Ag、抗-PreS1在慢性HBV感染不同转归人群[即e抗原阳性慢性乙型肝炎（CHB）组、e抗原阴性CHB组、非活动性HBsAg携带组、HBsAg血清学转换组1的检出情况及临床意义；同时分析PreS1Ag、抗-PreS1与HBV标志物、HBVDNA的关系。用SPSS13．0软件进行统计学处理。计数资料采用四格表或配对z。检验，计量资料采用独立样本f检验或秩和检验进行数据分析。结果PreS1Ag阳性率e抗原阳性CHB组为95．7％（67／70）、e抗原阴性CHB组为82．8％（24／29）、非活动性HBsAg携带组为13．2％（7／53）、HBsAg转换组为2．2％（1／46），四组人群PreS1Ag阳性率依次下降，x^2=141．7，P〈0．05，总体比较差异有统计学意义，可见PreS1Ag阳性率随病毒复制活跃程度下降而降低。抗-PreS1在四组间检出率差异无统计学意义。将HBsAg阳性的前三组（即e抗原阳性CHB组、e抗原阴性CHB组、非活动性HBsAg携带组）合并为一组，再与HBsAg血清学转换组比较，抗-PreS1阳性率分别为0．9％（14／152）和23．9％（14／46），x^2=6．919，P〈0．05，差异有统计学意义。PreS1Ag的吸光度值的平均秩次在高复制组为179．30，低复制组为133．80，高复制组明显高于低复制组，Z=-3．86，P〈0．05，差异有统计学意义；虽两组抗-PreS1的吸光度值平均秩次差异无统计学意义，但低复制组（23．86）较高复制组（21．08）有升高趋势。通过配对计数x^2检验分析抗-HBs与抗-PreS1的吻合性，X^2=0．262，P〉0．05，两者检出率差异无统计学意义。血清PreS1Ag、HBeAg、肝组织内HBcAg与HBVDNA有关联性，x^2值分别为33．840、24．159、4．854，P值均〈0．05。血清PreS1Ag与HBVDNA的关联程度（r=0．628）高于HBeAg（r=0．563）。结论PreS1Ag较HBeAg更敏感的反映了HBV复制的情况，抗-PreS1可能参与了HBV的清除，预示着慢性乙型肝炎的恢复。

Objective To investigate the positive ratio and clinical significance of PreS1Ag and anti-PreS1 in patients with chronic hepatitis B. Methods 428 patients with chronic HBV infection were collected, these patients were divided into e antigen-positive CHB group, e antigen-negative CHB group, inactive HBsAg carrier group and HBsAg serum conversion group. The difference of positive ratio of PreS1Ag and anfi-PreS1 among all groups or between every two groups were analyzed; The relationship of PreS1Ag and anti-PreS1 with HBV M and HBV DNA were also analyzed. SPSS13.0 softwar was used for statistical treatment. Fourfold table chi-square test or matched-pairs chi-square test was used for enumeration data, and independent sampler t test or rank-sum test was used for measurement data. Results The differences of PreS 1Ag among four groups were statistically significant （ x^2= 141.7, P 〈 0.05）. The positive ratio of PreS1Ag in e antigen-positive CHB group was 95.7%, followed by 82.8% in e antigen-negative CHB group, 132.% in inactive HBsAg carrier group and 2.2% in HBsAg serum conversion group. The difference of positive ratio of anti-PreS1 between HBsAg seroconversion group and HBsAg positive group was statistically significant （x^2 = 6.919, P 〈 0.05）, which indicated that anti-PreS1 had good correlation with HBsAg seroconversion. The average absorbance ratio of PreS lAg in high viral replication group （179.30） was higher than that in low viral replication group （133.87）, statistical significance appeared （Z = -3.86, P 〈 0.05）. Though the difference of absorbance ratio of anti-PreS1 between two groups had no statistical significance （P 〉 0.05）, descent trend was apparent with virus replication level ascending. We analyzed the concordance of anti-HBs and anti-PreS1 by matched-pairs chi-square test, result showed no statistical significance of detection rate between them, x^2= 0.262, P 〉 0.05. Serum PreS1Ag, HBeAg or HBcAg in liver tissue in reflecting hepatitis B replication had correlation with HBV DNA （ x^2= 33.840, 24.159, 4.854 in order, P 〈 0.05）. Correlation coefficient between PreS1Ag and HBV DNA was higher （r = 0.628） than that between HBeAg and HBV DNA （r = 0.563）. Conclusion PreS1Ag was more sensitive than HBeAg in diagnosing viral replication in patients with chronic hepatitis B. Anti-PreS1 as protective antibody may be involved in clearance of hepatitis B, positive result indicated recovery of chronic hepatitis B.