慢性乙型肝炎患者核苷酸类药物治疗过程HBsAg定量和HBV-DNA相关性研究

Correlation of HBsAg quantitation and HBV-DNA in patients with chronic hepatitis B treated by nucleotide drug

目的：探讨ELISA法检测HBsAg定量及实时荧光定量PCR（FQ-PCR）检测HBV-DNA在乙型肝炎病毒（HBV）感染核苷酸类药物诊疗中的应用价值,了解用ELISA法检测HBV-M不同的标志物组合时,其对应的HBV-DNA阴、阳性及阳性的拷贝数.方法：用实时荧光定量PCR（FQ-PCR）方法定量检测800例患者的血清HBV-DNA含量（临界值为500 copies/mL）,同时用ELISA法测定HBV血清标记物.结果：经FQ-PCR检测,347份HBsAg,HBeAg,抗-HBcAb,ProS 1-Ag都阳性的标本,HBV-DNA阳性率为98.7%,平均拷贝数为1.87×10^8copy/mL,差异具有统计学意义（P〈0.05）.HBAg,HBeAg,ProS 1-Ag一项或多项阳性者的HBV-DNA阳性率和平均拷贝数显高于三项抗原全阴者.结论：HBsA g是肝细胞受到HBV感染的标志,HBsA g清除是肝内HBV感染的免疫控制和抗病毒应答的标志;FQ-PCR可以快速而准确地检测HBV-DNA拷贝数.HBV-DNA可准确、灵敏地反映HBV复制.与HBV血清标记物联合应用可使诊断更准确,治疗更合理.对疾病的诊断,治疗过程的监测,愈后监控及药效评价等都具有很高的实用价值.

AIM： To investigate the value of HBV-DNA copies detected by real-time fluorescence quantitative PCR（FQ-PCR）and serological markers of HBV detected by ELISA method in the diagnosis and therapy of HBV infection. METHODS： HBV-DNA contents of 800 patients＇ serum were detected by real-time FQPCR. The cutoff is 500 copies/mL. Their serological markers of HBV were detected by ELISA method. Both results of HBV-DNA and serological markers of HBV were compared. RESULTS： In the 347 samples with HBsAg（＋）,HBeA g（＋）,HBcAb（＋）and ProS 1-Ag（＋） samples,HBV-DNA positive ratio and mean of copies were respectively 98.7% and 1.87×10^8 copies/mL.They were much higher than that of other groups（P0.05）.The HBsA g（-）,HBeAg（-）,ProS 1-Ag（-） group＇s positive ratio and copy number of HBV-DNA were much lower than that of HBsA g（＋） and/ or HBeA g（＋）,and / or ProS 1-Ag（＋） group,with statistically significant difference between the two groups（P0.05）. CONCLUSION： HBsA g is a sign of liver cells with HBV infection. HBsA g clearance is immune control of HBV infection in the liver and the mark of antiviral response. FQ-PCR is a fast and accurate technique to quantify the serum HBV-DNA.HBV-DNA can reflect HBV replication accurately. Combinating the HBV-DNA and the serological markers of HBV would make the diagnosis and therapy of HBV infection more reasonable and efficient.