乙型肝炎血清标志物模式及前S1抗原与乙型肝炎病毒DNA定量检测的关系

Relationship between hepatitis B serum markers and pre-S1 antigen with hepatitis B virus DNA quantitative detection

目的:探讨乙型肝炎病毒血清标志物(hepatitis B virus serum markers,HBV-M)及前S1抗原(preS1Ag)与HBV-DNA含量的相关性及其临床意义。方法:收集2016年12月至2018年1月于徐州医科大学附属医院就诊的556例乙型病毒肝炎患者的外周血。分别采用电化学发光法、磁微粒化学发光技术检测乙型肝炎病毒血清标志物和乙型肝炎病毒前S1抗原(HBV pre-S1Ag);运用荧光定量聚合酶链反应(fluorescence quantitative PCR,qRT-PCR)测定血清HBV-DNA含量。结果:HBV不同血清模式下,HBV-DNA与Pre-S1Ag检测结果比较差异有统计学意义(P<0.05)。乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)、乙型肝炎核心抗体(抗-HBc)阳性组(1,3,5模式)HBV-DNA检出率92.70%,pre-S1Ag检出率97.08%;HBsAg,乙型肝炎e抗体(HBeAb),抗-HBc阳性组(1,4,5模式)HBV-DNA检出率54.62%,pre-S1Ag检出率86.92%;HBsAg,HBeAg,HBeAb,抗-HBc阳性组(1,3,4,5模式)HBV-DNA检出率95.83%,pre-S1Ag检出率100%;HBsAg,乙型肝炎表面抗体(HBsAb),HBeAb,抗-HBc阳性组(1,2,4,5模式)HBV-DNA检出率41.67%,pre-S1Ag检出率79.17%。HBsAb,HBeAb,抗-HBc阳性组(2,4,5模式)均未检出HBV-DNA与pre-S1Ag。HBeAg阳性患者外周血中HBV-DNA和HBV pre-S1Ag检出率依次为92.74%和94.97%。结论:HBV血清标志物检测可辅助诊断是否感染HBV。Pre-S1Ag可作为一个较好的指标来判断乙型肝炎病毒的感染、复制以及活动性状况,但尚不能取代HBV-DNA定量。HBV-DNA定量与HBV血清标志物的联合应用可提高乙型肝炎的诊断效率。

Objective： To explore the relationship between hepatitis B virus DNA（HBV-DNA） and HBV serum markers（HBV-M） as well as HBV pre-S1 Ag. Methods： In all, 556 peripheral blood samples were prospectively collected from patients who are suffering from HBV at the Affiliated Hospital of Xuzhou Medical University between December 2016 and Januar y 2018. HBV-M and pre-S1 Ag were respectively detected with electrochemiluminescence and magnetic particles chemiluminescence method. The content of HBV-DNA was analyzed by fluorescence quantitative PCR（qRT-PCR）. Results： The positive rates between HBV pre-S1 Ag and HBV-DNA were significantly different among the different HBV-M mode group（P〈0.05）. In HBsAg, HBeAg, anti-HBc positive group（1, 3, 5 modes）, the positive rate of HBV-DNA and HBV pre-S1 Ag were 92.70% and 97.08% respectively. These quantitative indicators respectively reached 54.62% and 86.92% in HBsAg, HBeAb, anti-HBc positive group（1, 4, 5 modes）. In the model of HBsAg（＋）/HBeAg（＋）/HBeAb（＋）/anti-HBc（＋） group, the positive rate of HBV-DNA and HBV pre-S1 Ag were 95.83% and 100% respectively. In the model of HBsAg（＋）/HBsAb/HBeAb（＋）/anti-HBc（＋）, HBV-DNA detection rate was 41.67% and pre-S1 Ag account for 79.17%. However, HBV-DNA and HBV pre-S1 Ag were not detected in HBsAb, HBeAb, anti-HBc positive group（2, 4, 5 modes）. Overall, the positive rate of HBV-DNA and HBV pre-S1 Ag were respectively 92.74% and 94.97% in patients with HBeAg（＋）. Conclusion： The detection of HBV serum marker can help to diagnose HBV infection. HBV pre-S1 Ag is a better index, which can determine the infection, reproduction and activity of HBV, however, it still can＇t substitute HBV-DNA. HBV pre-S1 Ag, a good parameter in judgment the infection, replication and activity of HBV, can＇t replace the HBV-DNA quantification. The combination of the HBV-DNA quantification and the HBV serum markers detection can improve the diagnostic efficiency of hepatitis B.