HBsAg定量在HBV感染自然史中的变化及意义

Change in HBsAg quantification in the nature history of hepatitis B virus infection and its clinical significance

目的观察慢性HBV感染后不同临床状态HBs Ag定量分布特点及其与HBV DNA水平的相关性。方法收集2013年1月-2015年12月石家庄市第五医院的268例未经抗病毒治疗的HBV感染者进行横断面研究。依据HBV感染的不同时期分为4组,免疫耐受期29例、免疫清除期169例、低(非)复制期19例、再活动期51例。采用罗氏电化学发光法检测血清HBs Ag定量,PCR检测HBV DNA水平,并对HBs Ag和HBV DNA结果进行对数转换;对不同时期的结果进行统计分析。多组分析采用KruskalWallis H秩和检验,进一步两两比较采用Mann-Whitney U检验,相关性分析采用Spearman秩相关检验。结果 HBV感染的不同时期HBs Ag定量水平差异有统计学意义(χ2=71.830,P<0.001),免疫耐受期HBs Ag定量显著高于其他3期(P值均<0.05);免疫清除期HBs Ag定量显著高于低复制期和再活动期(P值均<0.05)。HBV DNA水平在各组间差异有统计学意义(χ2=117.028,P<0.001),免疫耐受期HBV DNA水平显著高于其他3期(P值均<0.05);免疫清除期HBV DNA水平显著高于低复制期和再活动期(P值均<0.05);再活动期显著高于低复制期(P值均<0.05)。HBs Ag定量和HBV DNA在免疫清除期和再活动期具有相关性(r值分别为0.559、0.338,P值分别为<0.001、0.014)。结论免疫耐受期HBs Ag定量和HBV DNA水平最高,显著高于其他3期。HBs Ag定量和HBV DNA在免疫清除期及再活动期显著相关。

Objective To investigate the distribution characteristics of HBsAg quantification in different clinical status after chronic hepatitis B virus（HBV） infection and its correlation with HBV DNA level. Methods A cross-sectional study was performed for 268 patients with HBV infection who did not receive antiviral therapy in The Fifth Hospital of Shijiazhuang from January 2013 to December 2015. According to the stage of HBV infection,these patients were divided into immune tolerance group with 29 patients,immune clearance group with 169 patients,low-or non-replication group with 19 patients,and reactivation group with 51 patients. Roche electrochemical luminescence was used to measure serum HBsAg quantification and PCR was used to measure HBV DNA level. Logarithmic transformation was performed for the results of HBsAg quantification and HBV DNA level,and a statistical analysis was performed for the results of different stages. The Kruskal-Wallis H rank sum test was used for the analysis of multiple groups,and the Mann-Whitney U test was used for further comparison between any two groups; a Spearman rank correlation analysis was also performed. Results HBsAg quantification varied in different stages of HBV infection（χ^2= 71. 830,P〈0. 001）; the immune tolerance group had significantly higher HBsAg quantification than the other three groups（all P〈0. 05）,and the immune clearance group had significantly higher HBsAg quantification than the low-replication group and the reactivation group（all P〈0. 05）. There was a significant difference in HBV DNA level between groups（χ2= 117. 028,P〈0. 001）; the immune tolerance group had a significantly higher HBV DNA level than the other three groups（all P〈0. 05）,the immune clearance group had a significantly higher HBV DNA level than the low-replication group and the reactivation group（all P〈0. 05）,and the reactivation group had a significantly higher HBV DNA level than the low-replication group（both P〈0. 05）. HBsAg quantification was correlated with HBV DNA level in immune clearance stage（r = 0. 559,P〈0. 001） and reactivation stage（r = 0. 338,P = 0. 014）. Conclusion HBsAg quantification and HBV DNA level in immune tolerance stage are higher than those in the other three stages,and HBsAg quantification is correlated with HBV DNA level in immune clearance stage and reactivation stage.