肝组织内HBsAg、HBcAg表达阴性与阳性的慢性乙型肝炎患者临床及肝脏病理的比较

Comparison of Clinical Manifestation and Hepatic Pathology in Patients with Chronic Hepatitis B with Negative and Positive Expression of HBcAg and HBsAg in Liver Tissue

目的比较肝组织内HBsAg、HBcAg表达阴性与阳性的慢性乙型肝炎(chronic hepatitis B,CHB)患者临床及肝脏病理的差异,分析肝组织内HBsAg、HBcAg表达强度与肝组织炎症活动度分级和纤维化分期的相关关系。方法收集CHB患者肝穿刺活检的标本317例进行免疫组化染色,同期记录各患者的年龄、性别、ALT、血清HBVDNA载量、肝组织炎症活动度分级和纤维化分期。比较肝组织内免疫组化染色HBsAg、HBcAg表达阴性与阳性组患者上述指标的差异。结果肝组织内HBsAg表达阴性患者年龄、ALT大于阳性患者,差异有统计学意义(P=0.002);血清HBVDNA载量显著低于阳性患者,差异有统计学意义(P=0.001);但肝组织炎症活动度分级及纤维化分期与阳性患者差异无统计学意义(P>0.05),且肝组织内HBsAg表达强度与肝组织炎症活动度分级及纤维化分期无相关关系。肝组织内HBcAg表达阴性患者年龄、ALT、肝组织炎症活动度分级及纤维化分期均大于阳性患者,差异有统计学意义(P<0.05);血清HBVDNA载量显著低于阳性患者,差异有统计学意义(P=0.00);并且肝组织内HBcAg表达强度与肝组织炎症活动度分级及纤维化分期存在负相关性(r=-0.227、r=-0.247)。结论肝组织内HBcAg是机体免疫攻击的主要靶抗原。肝组织内HBsAg可能不是免疫攻击的主要靶抗原,但其可能有扰乱机体对主要靶抗原的免疫攻击导致HBV不能被彻底清除的作用。

Objective To compare the clinical manifestation and hepatic pathology of patients with chronic hepatitis B （CHB） with negative and positive expression of in liver tissue. And to analyze the correlation between the expression intensity ofHBcAg and HBsAg in liver tissue and the activity grade of liver tissue inflammation and fibrosis stage. Methods 371 cases of liver biopsy specimens of patients with CHB were collected and stained with immunohistochemistry, and patients＇ age, sex, ALT, serum HB- VDNA load,liver tissue inflammation activity grade and fibrosis stage were recorded. We compared the differences in those indexes a- bove between the negative and positive groups. Results Compared with patients with positive HBsAg expression in liver tissue, the negative patients had a higher age and ALT level （P = 0. 002）and a significantly lower serum HBVDNA load（ P = 0. 001 ）. But there was no significant difference in the degree of activity of liver tissue inflammation and fibrosis staging between negative and positive pa- tients （P 〉 0. 05）, and there was no correlation between the expression intensity of HBsAg in liver tissue and the degree of liver in- flammation activity and fibrosis stage. The age, ALT,liver tissue inflammatory activity grading and fibrosis stage of patients with nega- tive HBcAg expression in liver tissue were higher than patients with positive HBcAg expression（ P 〈 0.05） ,but the serum HBVDNA load was significantly lower（P = 0. 00）. There was a negative correlation between the expression intensity of HBcAg in liver tissue and the degree of liver inflammation activity and fibrosis stage （ r = -0. 227, r = -0. 247 ）. Conclusion HBcAg in liver tissue is a major tar- get antigen attacked by immune system. AlthoughHBsAg may not be a major target antigen,it may disrupt the process that immune at- tacks the main target antigen, causing HBV cannot be completely eliminated.