乙型肝炎病毒复制及其抗原表达水平与慢性乙型肝炎肝组织病理状态的相关性

Correlations of hepatitis B virus replication and antigen expression levels with liver tissue pathological status in patients with chronic hepatitis B

目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)患者病毒复制及其抗原表达水平预测肝组织病理状态的价值。方法进行肝活检的CHB患者695例,血清HBs Ag和HBe Ag采用Abbott Architect I2000检测,血清HBV DNA采用实时定量PCR检测,肝组织HBs Ag和HBc Ag采用免疫组织化学法检测。结果 HBe Ag阳性患者,血清HBs Ag、HBe Ag水平和HBV DNA载量与病理学分级和分期均呈显著负相关(P<0.01);肝组织HBs Ag表达水平与病理学分级和分期均无显著相关性(P>0.05),HBc Ag表达水平与病理学分级和分期均呈显著负相关(P<0.01)。HBe Ag阴性患者,血清HBs Ag水平与病理学分级和分期均无显著相关性(P>0.05),HBV DNA载量与病理学分级和分期均呈显著正相关(P<0.01);肝组织HBs Ag表达水平与病理学分级和分期均无显著相关性(P>0.05),HBc Ag表达水平与病理学分级和分期分别呈显著正相关(P<0.05)和无显著相关性(P>0.05)。有序Logistic回归分析显示,HBe Ag阳性患者血清HBs Ag、HBe Ag水平和HBV DNA载量、肝组织HBc Ag表达水平预测病理学分级和分期的回归系数均有统计学意义(P<0.05);HBe Ag阴性患者,只有血清HBV DNA载量预测病理学分级的回归系数有统计学意义(P<0.01)。结论 HBe Ag阳性患者,血清HBs Ag、HBe Ag水平和HBV DNA载量、肝组织HBc Ag表达水平均有预测肝组织病理学分级和分期的意义;HBe Ag阴性患者,只有血清HBV DNA载量有预测肝组织病理学分级的意义。

Objective To investigate the value of hepatitis B virus replication and antigen expression levels for predicting liver tissue pathological status in patients with chronic hepatitis B（ CHB）. Methods Six hundred and ninetyfive patients with CHB underwent liver biopsy. Serum HBs Ag and HBe Ag were determined by Abbott Architect I2000,serum HBV DNA was measured by real-time quantitative PCR; liver tissue HBs Ag and HBc Ag were assayed by immunohistochemistry. Results In HBe Ag-positive patients,serum HBs Ag,HBe Ag levels and HBV DNA loads were negatively correlated significantly with pathological grading and staging（ P〈0. 01）; liver tissue HBs Ag expression levels was not correlated significantly with pathological grading and staging（ P〉0. 05）,and liver tissue HBc Ag expression levels was negatively correlated significantly with pathological grading and staging（ P〈0. 01）. In HBe Ag-negative patients,serum HBs Ag levels were not correlated significantly with pathological grading and staging（ P〉0. 05）,and serum HBV DNA loads were positively correlated significantly with pathological grading and staging（ P〈0. 01）; liver tissue HBs Ag expression levels were not correlated significantly with pathological grading and staging（ P〉0. 05）,and liver tissue HBc Ag expression levels were positively correlated significantly with pathological grading（ P〈0. 05） and not correlated significantly with pathological staging（ P〉0. 05）. The ordinal Logistic regression analysis showed that the regression coefficients of serum HBs Ag,HBe Ag levels and HBV DNA loads,and liver tissue HBc Ag expression levels for predicting pathological grading and staging had statistical significance in HBe Ag-positive patients（ P〈0. 05）; and the regression coefficient of serum HBV DNA loads for predicting pathological grading had statistical significance in HBe Ag-negative patients（ P〈0. 01）. Conclusion Serum HBs Ag,HBe Ag levels and HBV DNA load,and liver tissue HBc Ag expression levels are significant for predicting pathological grading and staging in HBe Ag-positive patients; and only serum HBV DNA load is significant for predicting pathological grading in HBe Ag-negative patients.