乙肝病毒外膜大蛋白检测在临床诊断与治疗中的意义

Clinical significance of hepatitis B virus large protein detection in clinical diagnosis and treatment

目的:对乙肝病毒血清学标志物HBV-M(包括HBsAg、HBsAb、HBeAg、HBeAb、HBcAb),乙肝病毒外膜大蛋白(HBV-Lp),乙肝病毒前S1抗原(HBV-Pres1)和乙肝病毒脱氧核糖核酸(HBV-DNA)联合检测结果进行比较,观察乙肝病毒外膜大蛋白(HBV-Lp)检测在临床诊断治疗乙肝中的应用价值,寻求比现有常规检测更敏感、更准确的实验室乙肝检测方法。方法:将感染科461例标本分成5组进行比较分析:78例乙肝表面抗原(吸收度A值<1)阴性血清标本为A对照组;9例HBsAg弱阳性(吸收度A值为1~2)血清标本为B组;201例HBsAg阳性(吸收度A值>2)且HBV-DNA含量<5×102IU/ml的血清标本为C组;133例HBsAg阳性(吸收度A值>2)且HBV-DNA含量5×102~5×105IU/ml的血清标本为D组;40例HBsAg阳性(吸收度A值>2)且HBV-DNA含量>5×105IU/ml的血清标本为E组。用酶联免疫吸附法检测HBV-M,HBV-Lp和HBVPres1,PCR-荧光探针法定量检测HBV-DNA。结果:A组和B组未见Pre-S1和HBV-LP结果异常。C、D、E组中HBeAg的阳性率依次为0.99%,6.02%,77.50%;Pre-S1的阳性率依次为29.35%,42.86%,90.00%;HBVLP的阳性率依次为38.31%,55.64%,95.00%,HBV-LP、HBeAg和Pre-S1的阳性率可能性均随着HBV-DNA含量的增加而增大(P<0.05)。C、D、E组中HBeAg、Pre-S1和HBV-LP的检出率分别为10.96%,40.64%,50.53%,HBV-LP的检出率明显高于HBeAg和Pre-S1的检出率(P<0.05)。通过对相同HBV-DNA含量组的HBV-LP、HBeAg和Pre-S1阳性率进行统计学t检验比较,可以看出HBV-LP的检出率明显高于HBeAg和PreS1的检出率(P<0.05)。C、D、E组中HBV-LP的平均吸收度A值依次为2.53,5.35,13.93。HBV-DNA含量的增加伴随着有HBV-LP浓度的增加(P<0.05)。结论:HBV-LP检测比HBeAg和Pre-S1检测敏感性强,被检出的可能性更大,漏检的可能性更小。HBV-LP检测与HBV-DNA检测呈正相关性,HBV-LP在HBsAg阳性而HBV-DNA检测阴性时有理想的检出率,可能会对乙型肝炎诊断治疗进行补充作用。

Objective：By comparing the result of serological markers for hepatitis B virus HBV-M（including HBsAg,HBsAb,HBeAg,HBeAb,HBcAb）,hepatitis B virus large outer membrane protein（HBV-Lp）,former S1 antigen hepatitis B virus（HBV Pres1）and hepatitis B virus DNA（HBV DNA）,observe the value of hepatitis B virus large outer membrane protein（HBV-Lp）in the clinical diagnosis and treatment of viral hepatitis B,to seek a more sensitive and accurate method of laboratory testing than the existing conventional detection.Method：The 461 specimens from the Infectious Disease Department of the hospital were divided into five groups for comparison and analysis：78 cases of serum specimens with HBsAg negative（absorbance Avalue is1）for control group A;9 cases of serum specimens with HBsAg weak positive（absorbance A value is 1-2）were in group B;201 cases of serum specimens with HBsAg positive（absorbance Avalue is2）and HBV-DNA content5×102 IU/ml were in group C;133 cases of serum specimens with HBsAg positive（absorbance Avalue is2）and HBV-DNA content 5×102-5×105 IU/ml were in group D;40 serum samples with HBsAg positive（absorbance Avalue is2）and HBV-DNA content5×105 IU/ml were group E.HBV-M,HBV-Lp and HBV-Pres1 were detected by enzyme-linked immunosorbent assay,and HBV-DNA was quantitatively detected by PCR-fluorescence probe method.Result：No abnormalities of Pre-S1 and HBV-LP were found in groups A and B.The positive rates of HBeAg in the C,D and E groups were 0.99%,6.02%,and 77.50%,respectively;the positive rates of Pre-S1 were 29.35%,42.86%,and90.00%,respectively;the positive rate of HBV-LP was 38.31%,55.64%,95.00%,The positive possibility of HBV-LP,HBeAg and Pre-S1 increased with the increase of HBV-DNA content（P0.05）.The detection rates of HBeAg,Pre-S1,and HBV-LP in the C,D,and E groups were 10.96%,40.64%,and 50.53%,respectively.The detection rate of HBV-LP was significantly higher than that of HBeAg and Pre-S1（P0.05）.By comparing the HBV-LP,HBeAg,and Pre-S1 positive rates of the same HBV-DNA content group by statistical t test,it can be seen that the detection rate of HBV-LP is significantly higher than the detection rate of HBeAg and Pre-S1（P0.05）.The average absorbance Avalues of HBV-LP in the C,D,and E groups were 2.53,5.35,and 13.93,respectively.The increase in HBV-DNA content was accompanied by an increase in HBV-LP concentrations（P0.05）.Conclusion：HBV-LP has a more sensitive and higher detection rate than HBeAg and Pre-s1.The detection of HBV-LP was positively correlated with the detection of HBV-DNA,HBV-LP had an ideal detection rate when HBsAg was positive and HBV-DNA was negative,which may complement the diagnosis and treatment of hepatitis B.