HBsAg定量水平在HBeAg阴性慢性乙型肝炎患者肝纤维化中的价值

The value of the quantitative levels of HBsAg in HBeAg⁃negative chronic hepatitis B patients with liver fibrosis

目的血清乙型肝炎表面抗原(qHBsAg)定量水平已被评价为在慢性乙型肝炎患者组中作为肝组织学纤维化的标志。但研究对象很少是HBeAg阴性慢性HBV患者,本研究的目的是评估qHBsAg定量水平在未经治疗的HBeAg阴性慢性乙肝患者的肝纤维化分期中是否有诊断价值。方法回顾性分析患者HBsAg定量水平与HBV DNA、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肝纤维化等指标的关系。在基线时测量HBsAg水平作为单点定量,评估的qHBsAg临界点为1000 IU/mL,以证明它是否能很好的区分轻度纤维化(S0⁃1)和显著纤维化(S2⁃4)患者。结果qHBsAg水平>1000 IU/mL与qHB⁃sAg水平<1000 IU/mL相比,qHBsAg水平>1000 IU/mL的患者更有可能发生S2⁃4纤维化(P=0.029),差异具有统计学意义。但在不同纤维化分期中,发生S0⁃1(3.53±0.15)和S2⁃4纤维化(3.62±0.16,P=0.07)患者的qHBsAg差异并无统计学意义。当HBV DNA(>2000 IU/mL)联合HBsAg临界值评估不同肝纤维化分期时,出现显著纤维化(S2⁃4)的发生率与qHBsAg水平无明显的相关性。血清qHBsAg不能准确鉴定纤维化分期(AUROC,0.62,cut⁃off值为3758 IU/mL,敏感性为73.1%,特异性54.2%)。结论血清HBsAg水平不能区分具有显著纤维化(S2⁃4)的患者。超过一半的无显著纤维化患者的qHBsAg水平>1000 IU/mL。

Objective The quantitative level of serum hepatitis B surface antigen(qHBsAg)has been evaluated as a marker of liver histological fibrosis in the chronic hepatitis B patient group.However,few study focuses on HBeAg⁃negative chronic HBV patients.The purpose of this study is to assess whether the quantitative level of qHBsAg has diagnostic value in staging of liver fibrosis in untreated HBeAg⁃negative chronic HBV patients.Methods The relationships between the quantitative levels of HBsAg and HBV DNA,alanine aminotransferase(ALT),aspartate aminotransferase(AST),liver fibrosis and other indicators were retrospectively analyzed.The HBsAg levels were measured at baseline as a single point of quantification and the cut⁃off point for the evaluated qHBsAg was 1000 IU/mL.It was used to prove whether it could distinguish patients with mild fibrosis(S0⁃1)from significant fibrosis(S2⁃4).Results Compared with patients with qHBsAg level<1000 IU/mL,patients with qHBsAg level>1000 IU/mL are more likely to develop S2⁃4 fibrosis(P=0.029)and the difference is statistically significant.However,there was no significant difference in qHBsAg in patients with S0⁃1(3.53±0.15)and S2⁃4 fibrosis(3.62±0.16,P=0.07)in different fibrosis stages.When HBV DNA(>2000 IU/mL)combined with HBsAg cut⁃off valueto evaluate different liver fibrosis stages,the incidence of significant fibrosis(S2⁃4)has no obvious correlation with qHBsAg level.qHBsAg could not accurately identify the stage of fibrosis(AUROC,0.62,cut⁃off value of 3758 IU/mL,sensitivity of 73.1%,specificity of 54.2%).Conclusion Serum HBsAg levels could not distinguish patients with significant fibrosis(S2⁃4).In addition,more than half of patients with no significant fibrosis had qHBsAg levels greater than 1000 IU/mL.