HBsAg定量检测在慢性乙型肝炎自然病程中的意义

The significance of HBsAg quantitative analysis in the natural history of chronic hepatitis B

目的研究慢性乙型肝炎病毒(HBV)感染自然病程中HBsAg水平变化情况以及和HBV DNA的关系。方法将183名HBV感染者按感染的不同阶段分为免疫耐受期(IT)42例,免疫清除期(IC)46例,非/低水平复制期(LR)57例,和再活动期(HBeAg阴性肝炎组ENH)38例,回顾性分析每个阶段血清中HBsAg和HBV DNA水平以及两者之间的关系。结果 HBsAg含量分别为IT期最高[(3.81±0.46)Ig IU/mL],其次为IC期[(3.41±0.77)Ig IU/mL],最低是LR期[(2.87±0.61)Ig0.61IU/mL],每期之间HBsAg含量差异有统计学意义(P<0.05),ENH组HBsAg含量又有所升高[(3.31±0.78)Ig IU/mL]。IT期HBsAg与HBV DNA无相关(r=0.231,P>0.05),IC期HBsAg与HBV DNA呈正相关(r=0.612,P<0.05),ENH期两者无相关(r=0.189,P>0.05);不同时期HBsAg含量与ALT均无相关性。结论 HBV感染的不同阶段HBsAg水平有差异,IT期最高,进入IC期后开始下降,在LR期降至最低,ENH期再度升高,HBsAg与HBV DNA仅在IC期有相关性,血清HBsAg的表达与不同的免疫背景有关。

Objective To study the HBsAg levels in the natural history of chronic hepatitis B and the correlation with HBV DNA. Methods 183 patients with Chronic HBV infection were classified into 4 phases： 42 in immune tolerance （IT） phase, 46 in immune clearance （IC） phase, 57 in inactive/low reaction （LR） phase, and 38 in late reactivation phase （ HBeAg negative hepatitis, ENH ）. The HBsAg levels and the correlation with HBV DNA in the four phases were analyzed retrospectively. Results The median HBsAg lev- els varied significantly during the 4 phases of infection （ P 〈 0.05 ）. The highest HBsAg level was in IT phase [ （ 3.81 _＋ 0.46 ） Ig IU/mL ], followed by that in IC phase [ （3.41 -＋ 0.77 ）Ig IU/mL ], while the lowest was in LR phase [ （2.87 _＋ 0.61 ）Ig IU/mL ]. The HBsAg level went up in ENH phase [ （3.31 _＋ 0.78）Ig IU/mL]. In IC phase, HBsAg was positively correlated with HBV DNA level （r=0. 612, P 〈 0.05）. There were no significant correlations between HBsAg and HBV DNA in IT and ENH phases （r =0. 231, P 〉 0.05 ; r = 0. 189, P 〉 0.05 ）. There were also no significant correlations between HBsAg and ALT in all 4 phases. Conclusion HB- sAg levels differ significantly during the 4 phases of infection; serum HBsAg progressively declines from immune tolerance to inactive phase, and increases in late reactivation phase. HBsAg is positively correlated with HBV DNA only in immune clearance phase. These re- sults indicate that the expression of serum HBsAg is related with different immune mechanisms.