乙型肝炎不同HBsAg浓度与血清人宫颈癌基因蛋白、甲胎蛋白水平的变化及其相关性

Correlations of different concentrations of HBsAg in HBV patients with the levels of HCCR and AFP

目的探讨血清乙型肝炎病毒表面抗原(HBs Ag)浓度与人宫颈癌基因蛋白(HCCR)及甲胎蛋白(AFP)的相关性。方法采集2013年6月至2014年9月在湖南省益阳医学高等专科学校附属医院传染科住院的400例HBs Ag阳性患者为观察组,根据HBs Ag浓度分为A、B、C、D组[A组87例(HBs Ag 0.5~150μg/L)、B组98例(HBs Ag 151~300μg/L)、C组113例(HBs Ag 301~450μg/L)、D组102例(HBs Ag>450μg/L)],另外根据疾病类型分为肝炎组183例、肝硬化组116例、肝细胞癌(HCC)组101例;以100例健康体检者作为健康对照组。采用酶联免疫吸附试验(ELISA)检测HCCR,化学发光法检测HBs Ag和AFP,并对HBs Ag浓度与HCCR、AFP进行Pearson相关性分析。结果不同HBs Ag浓度组血清HCCR、AFP均明显高于健康对照组,且HBs Ag浓度越高,HCCR、AFP水平越高[HCCR(g/L):9.28±2.24、13.31±3.00、16.83±4.26、24.50±8.04比6.23±2.30,AFP(μg/L):6.36±1.63、7.56±4.20、15.36±8.77、37.44±25.36比2.50±0.92,均P<0.05],且A、B、C、D组HCCR与AFP均呈正相关(r值为0.73、0.51、0.63、0.79,均P<0.05)。以HCCR>15 g/L、AFP>9μg/L为阳性,不同HBs Ag浓度A、B、C、D组HCCR、AFP阳性率随HBs Ag浓度的增加均呈升高趋势[HCCR:2.30%(2例)、16.33%(16例)、57.52%(65例)、75.49%(77例);AFP阳性率为0%(0例)、10.24%(10例)、51.33%(58例)、65.69%(67例)],HCC组HCCR、AFP阳性率明显高于肝炎组和肝硬化组[HCCR:89.11%(90例)比21.86%(40例)、25.86%(30例);AFP:71.29%(58例)比20.77%(38例)、21.55%(25例);均P<0.01];不同分组方法组内比较,HCCR阳性率均明显高于AFP阳性率(均P<0.01)。结论 HCCR浓度的高低在一定程度上可反映肝细胞的实质性炎性病变及癌变程度,联合检测HBs Ag高浓度HBV感染者的HCCR和AFP对观察肝脏损害的演变过程有重要的临床价值。

Objective To investigate the relevance of the concentration of hepatitis B virus surface antigen（HBs Ag） to human cervical cancer gene protein（HCCR） and alpha fetoprotein（AFP）.Methods From June 2013 to September 2014,400 patients with positive HBs Ag admitted to infection department of the Affiliated Hospital of Yiyang Medical College in Hunan Province as the observation group,according to the concentration of HBs Ag was divided into A,B,C,D groups,A group of 87 cases（0.5～150 g/L）,98 cases in B group（151～300 g/L）,C group of 113 cases（301～450 g/L）,102 cases in D group（ 〉450 g/L）.In addition,according to the type of disease was divided into hepatitis group 183 cases,116 patients with cirrhosis and hepatocellular carcinoma（HCC） group of 101 cases.100 cases of healthy people were taken as control group.Enzyme linked immunosorbent assay（ELISA） was used to detect HCCR,chemiluminescence method was used to detect HBs Ag and AFP,and Pearson correlation analysis was performed.Results Serum HCCR and AFP in different concentrations of HBs Ag groups were significantly higher than the control group,and the higher the concentration of HBs Ag,the higher the level of HCCR and AFP [HCCR（g/L）：9.28±2.24,13.31±3.00,16.83±4.26,24.50±8.04 vs.6.23±2.30;AFP（μg/L）：6.36±1.63,7.56±4.20,15.36±8.77,37.44±25.36 vs.2.50±0.92,all P 〈0.05],and A,B,C,D groups HCCR and AFP were positively correlated（r = 0.73,0.51,0.63,0.79,all P 〈0.05）.With HCCR 〉15 g/L,AFP 〉9 g/L positive,with the increase of HBs Ag concentration in different HBs Ag concentration groups,HCCR,AFP positive rate were increased [the positive rate of HCCR was 2.30%（2 cases）,16.33%（16 cases）,57.52%（65 cases）,75.49%（77 cases）;the positive rate of AFP was 0%（0 case）,10.24%（10 cases）,51.33%（58 cases）,65.69%（67 cases）],HCCR and AFP positive rates in HCC group were significantly higher than the positive rate of hepatitis group and cirrhosis group [the positive rate of HCCR was 89.11%（90 cases） vs.21.86%（40 cases）,25.86%（30 cases）;the positive rate of AFP was 71.29%（58 cases） vs.20.77%（38 cases）,21.55%（25 cases）,all P〈 0.01];comparison of methods of different groups within the group,the positive rate of HCCR was significantly higher than the positive rate of AFP（all P〈 0.01）.Conclusions The concentration of HCCR can reflect the parenchymal inflammatory lesions and canceration degree of hepatocytes to a certain extent.Meanwhile,detecting HCCR and AFP in HBs Ag infected patients with high concentration of HBV has important clinical value in the observation of the evolution of liver damage.