不同HBV感染自然史状态及肝硬化患者抗-HBc水平及其临床意义

Anti-HBc levels in patients with different natural history of chronic HBV infection and cirrhosis and its clinical significance

目的研究慢性乙型肝炎病毒(HBV)感染不同自然史状态及肝硬化患者血清乙型肝炎病毒核心抗体(抗-HBc)水平及其用于自然史状态区别诊断的临床价值。方法纳入2015年3月至2016年6月就诊的慢性HBV感染患者160例,根据自然史状态分为免疫耐受组(n=43)、乙型肝炎病毒e抗原(HBeAg)阳性慢性乙型肝炎(CHB)组(n=37)、非活动携带组(n=39)及HBeAg阴性CHB组(n=41),同时纳入HBeAg阳性(n=44)及阴性肝硬化患者(n=46)。收集患者一般情况,检测血清乙型肝炎病毒表面抗原(HBsAg)、HBeAg、抗-HBc、HBV DNA载量及HBV基因型。分析抗-HBc与临床指标的相关性及其用于自然史状态区别诊断的价值。结果不同自然史状态抗-HBc由高至低为:HBeAg阳性CHB组(4.22±0.68)log_(10)IU/mL、HBeAg阴性CHB组(3.89±0.88)log_(10)IU/mL、非活动携带组(3.07±0.68)log_(10)IU/mL及免疫耐受组(2.88±0.82)log_(10)IU/mL。HBeAg阳性及阴性肝硬化患者抗-HBc分别为(3.04±0.82)、(3.15±0.86)log_(10)IU/mL。HBeAg阳性CHB组抗-HBc与ALT(r=0.353,P=0.032)及AST(r=0.421,P=0.009)呈正相关;HBeAg阴性CHB组抗-HBc与HBV DNA(r=0.343,P=0.028)、ALT(r=0.458,P=0.003)及AST(r=0.495,P=0.001)呈正相关。抗-HBc区别诊断免疫耐受状态及HBeAg阳性CHB的AUC为0.903,区别非活动携带状态及HBeAg阴性CHB的AUC为0.833。结论不同慢性HBV感染自然史状态下血清抗-HBc水平存在明显差异,且抗-HBc可用于慢性HBV感染自然史状态的区别诊断,诊断价值高于HBsAg水平。

Objective To investigate the serum anti-HBc level in patients with different natural history of chronic hepatitis B virus （HBV） infection and cirrhosis,and its clinical value for distinguishing the natural history statue. Methods A total of 160 pa- tients with chronic HBV infection from March 2015 to June 2016 were enrolled,and they were divided into immune tolerance group （n=43）, HBeAg-positive chronic hepatitis B （CHB） group （n = 37）, inactive carrier group （n = 39） and HBeAg-negative CHB group （n=41）. A total of 44 patients with HBeAg-positive cirrhosis and 46 patients with HBeAg-negative cirrhosis were enrolled too. The general conditions data were collected,and HBsAg, HBeAg,anti-HBc, HBV DNA load and HBV genotype were detected. The associations between anti-HBc level and clinical parameters were analyzed,and the diagnostic value of anti-HBc for distinguis- hing different natural histories was analyzed. Results The anti-HBc levels in different natural history from high to low were as fol- lowing： HBeAg-positive CHB group （4.22 ± 0.68） log10 IU/mL, HBeAg-negative CHB group （3.89 ± 0.88） log10 IU/mL, inactive carrier group （3.07±0.68）log10 IU/mL and immune tolerance group （2.88±0.82）log10 IU/mL. The anti-HBc levels in HBeAg- positive and HBeAg-negative cirrhosis patients were （3.04±0.82） and （3.15±0.86） log10 IU/mL, respectively. In HBeAg-posi- tive CHB group,the anti-HBc was positively associated with ALT （r=0. 353,P=0. 032） and AST （r=0. 421,P=0. 009）. In HBeAg-negative CHB group, the anti-HBc was positively associated with HBV DNA （r= 0. 343, P = 0. 028）, ALT （r= 0. 458, P = 0. 003） and AST （r=0. 495 ,P=0. 001）. The AUC of anti-HBc used to distinguish immune tolerance from HBeAg-positive CHB was 0. 903,and the AUC used to distinguish inactive carrier from HBeAg-negative CHB was 0. 833. Conclusion Anti-HBc levels in different natural history of chronic HBV infection are significantly different,and anti-HBc could be used to distinguish the natural history statue of chronic HBV infection with a higher diagnostic value than HBsAg.