HBsAg定量检测对慢性重型乙型肝炎患者预后的预测价值

Value of HBsAg quantification in predicting the prognosis of patients with chronic severe hepatitis B

目的探索HBs Ag定量对慢性重型乙型肝炎患者预后的预测价值。方法回顾性分析2012年1月^(-2)015年8月吉林大学第一医院收治的慢性HBV感染的重型肝炎患者61例,并随访患者90 d。患者血清HBs Ag水平通过微粒子发光法检测。受试者工作特征曲线用于选取HBs Ag的临界值,据此将患者分为4组:HBs Ag<1.63 log10IU/ml组、1.63 log10IU/ml^2.61 log10IU/ml组、2.61 log10IU/ml^3.62 log10IU/ml组和HBs Ag>3.62 log10IU/ml组。计量资料多组间比较采用Kruskal-Wallis检验,2组间比较采用Mann-Whitney U检验。计数资料组间比较采用Fisher精确检验。多组间生存曲线比较采用log-rank检验。Cox单因素和多因素回归用于分析与慢性重型乙型肝炎预后相关的因素,获得每个变量的风险比(HR)。相关性比较采用Spearman相关分析。结果4组患者的生存时间差异有统计学意义(χ~2=18.261,P<0.001)。HBs Ag<1.63 log10IU/ml组的90 d生存率显著低于2.61log10IU/ml^3.62 log10IU/ml组(χ~2=10.283,P=0.001)和HBs Ag>3.62 log10IU/ml组(χ~2=17.236,P<0.001)。Cox多因素回归分析结果显示:HBs Ag[HR=0.562,95%可信区间(95%CI):0.364~0.870,P=0.010]、血尿素氮(HR=1.111,95%CI:1.042~1.185,P=0.001)、肝性脑病(HR=4.123,95%CI:1.729~9.830,P=0.001)和MELD评分(HR=1.093,95%CI:1.024~1.166,P=0.007)是影响慢性重型乙型肝炎患者90 d生存率的独立因素。HBs Ag与HBV DNA呈低度正相关(r=0.326,P=0.01)。结论血清HBs Ag水平为预测慢性重型乙型肝炎预后的重要因子。

Objective To investigate the value of HBs Ag quantification in predicting the prognosis of patients with chronic severe hepatitis B. Methods The clinical data of 61 patients with chronic severe hepatitis B who were admitted to The First Hospital of Jilin University from January 2012 to August 2015 were analyzed retrospectively and were followed up for 90 days. Chemiluminescent microparticle immunoassay was used to measure the serum HBs Ag level. The receiver operating characteristic curves were used to determine the cut- off value of HBs Ag,and according to this value,the patients were divided into HBs Ag 1. 63 log10 IU / ml group,1. 63- 2. 61 log10 IU / ml group,2. 61-3. 62 log10 IU / ml group,and HBs Ag 3. 62 log10 IU / ml group. The Kruskal- Wallis test was used for comparison of continuous data between multiple groups,the Mann- Whitney U test was used for comparison of continuous data between two groups,and the Fisher＇ s exact test was used for comparison of categorical data between groups. The log- rank test was used for comparison of survival curves between multiple groups. The univariate and multivariate Cox regression analyses were used to analyze the factors related to the prognosis of chronic severe hepatitis B and obtain the hazards ratio（ HR） of each variable. The Spearman correlation analysis was used for correlation analysis. Results The survival time showed a significant difference between the four groups（ χ-2= 18. 261,P〈0. 001）. The HBs Ag 1. 63 log10 IU / ml group had a significantly lower 90- day survival rate than the 2. 61- 3. 62 log10 IU / ml group（ χ-2= 10. 283,P = 0. 001） and the HBs Ag 3. 62 log10 IU / ml group（ χ-2= 17. 236,P〈0. 001）. The multivariate Cox regression analysis showed that HBs Ag（ HR = 0. 562,95% CI：0. 364- 0. 870,P = 0. 010）,blood urea nitrogen（ HR = 1. 111,95% CI： 1. 042- 1. 185,P = 0. 001）,hepatic encephalopathy（ HR =4. 123,95% CI： 1. 729- 9. 830,P = 0. 001）,and Model for End- Stage Liver Disease（ MELD） score（ HR = 1. 093,95% CI： 1. 024-（-1）. 166,P = 0. 007） were independent risk factors for the 90- day survival rate of patients with chronic severe hepatitis B. HBs Ag showed a low correlation with HBV DNA（ r = 0. 326,P = 0. 01）. Conclusion Serum HBs Ag level is an important factor in predicting the prognosis of patients with chronic severe hepatitis B.