乙型肝炎病毒相关肝细胞癌中血清乙型肝炎表面抗原表达的横断面研究

Hepatitis B surface antigen levels in hepatitis B virus-related hepatocellular carcinoma., a retrospective cross- Sectional study

目的探讨HBV相关肝细胞癌（HCC）患者血清HBsAg的表达情况。方法收集2009年6月至2013年12月HBV相关性HCC患者226例。观察不同巴塞罗那临床分期（BCLC）HCC患者的人口学特征，以及有无合并肝硬化、不同病毒学指标时患者HBsAg表达水平。HBsAg定量检测采用化学发光法。统计学处理采用t检验、χ2检验、Kruskal-Wallis H秩和检验和Mann-Whitney U秩和检验。结果226例患者中男201例，女25例。不同年龄段HCC患者的HBsAg差异有统计学意义（χ2＝12.30，P＝0.015）；不同性别HCC患者的HBsAg差异无统计学意义（Z＝－0.35，P〉0.05）。无肝硬化组与肝硬化组的HBsAg水平差异无统计学意义（Z＝－0.80，P＝0.419）；肝硬化组HCC患者不同肝功能分级的HBsAg差异无统计学意义（χ2＝2.15，P＝0.341）；HBeAg阳性组的HBsAg水平明显高于HBeAg阴性组，差异有统计学意义（Z＝－3.67，P〈0.01）；HBV DNA阳性组的HBsAg水平明显高于HBV DNA阴性组，差异有统计学意义（Z＝－4.80，P〈0.01）。秩和检验提示各BCLC分期患者的HBsAg差异无统计学意义（χ2＝8.05，P＝0.09）。有无门静脉侵犯、有无淋巴结转移、有无远处转移HCC患者的HBsAg水平差异均无统计学意义（Z值分别为－0.65、－0.03和－1.24，均P〉0.05）。BCLC各分期间不同HBsAg水平患者的构成比差异有统计学意义（χ2＝28.17，P＝0.005）。结论HBV相关性HCC患者不同BCLC分期的HBsAg水平无明显差异，提示HBsAg在发生HCC后可能对疾病的进展不起主要作用。

Objective To investigate the distribution of serum hepatitis B surface antigen （HBsAg） levels in patients with hepatitis B virus （HBV）-related hepatocellular carcinoma （HCC）.MethodsA total of 226 cases of HBV-related HCC were collected from June 2009 to December 2013. Demographic characteristics of patients with different barcelona clinica liver cancer （BCLC） stages, the status of cirrhosis and HBsAg levels with different virological indicators were compared. HBsAg quantification was tested by chemiluminescence. The statistical analysis was conducted by t test, χ2 test, Kruskal-Wallis H rank sum test and Mann-Whitney U rank sum test.ResultsA total of 226 cases were included with 201 male patients and 25 female patients. HBsAg levels in HBV-related HCC patients with different ages were significantly different （χ2=12.30, P=0.015）, but with no statistical difference in those with different gender （Z=-0.35, P〉0.05）. The HBsAg levels were not significantly different between patients with or without liver cirrhosis （Z=-0.80, P=0.419）. HBsAg levels in liver cirrhosis cases with different liver function stages were not significant different （χ2=2.15, P=0.341）. HBsAg levels in HBeAg-positive group or HBV DNA positive group were significantly higher than those in HBeAg-negative group or HBV DNA negative group, respectively （Z=-3.67 and -4.80, respectively, both P〈0.01）. The HBsAg levels in patients with different BCLC stages were not significantly different （χ2=8.05, P=0.09）. No significant differences were found in HBsAg levels between patients with or without portal vein violation, lymph node transfer or distant transfer （Z=-0.65, -0.03 and -1.24, respectively, all P〉0.05）. The constituent ratios of patients with different HBsAg levels in different BCLC stages were statistically different （χ2=28.17, P=0.005）.ConclusionsThere are no significant differences of HBsAg levels in patients with different BCLC stages, indicating that HBsAg may not be a contributor for disease progression after emergence of HCC.