4336例ΗΙV感染者HBV血清标志物检测结果的回顾性研究

A retrospective study on the detection results of HBV serum markers in 4336 HIV infected patients

目的研究免疫水平对乙型肝炎(简称乙肝)病毒(HBV)血清标志物的影响及两者的相关性。方法利用医院门诊电子系统提取2016年1月至2019年6月初诊艾滋病病毒(HIV)感染者的相关信息资料,对4336例HIV感染者人口学资料、免疫学及HBV血清标志物的相关数据进行回顾性分析。结果4336例初诊HIV感染者其中乙肝表面抗原(HBsAg)(+)人群在不同CD4^(+)T淋巴细胞(CD4细胞)水平的乙型肝炎。抗体(HBeAb)阳性率差异有统计学意义(χ^(2)=14.064,P=0.015):进一步分析发现在CD4细胞<300个/μL时CD4细胞越低HBeAb阳性率越低(χ^(2)_(<100与200~299)=12.414,P<_(100与200~299)<0.001;χ^(2)_(100~199与200~299)=6.268,P_(100~199与200~299=0.012)),同时HBeAb阳性率有随CD4细胞水平增加而增加的趋势(χ^(2)=6.594,P=0.010),并发现CD4细胞、年龄[比值比(OR)>1,P<0.001]是HBeAb(+)的影响因素,随着年龄增长HBeAb阳性率增加。而HBsAg(-)人群在不同CD4细胞水平的乙肝表面抗体(HBsAb)阳性率存在统计学差异(χ^(2)=22.80,P<0.001),并随着CD4细胞下降HBsAb(+)阳性率在下降,分析发现在CD4细胞≥300个/μL时,各组比CD4细胞<100个/μL组阳性率高(χ^(2)_(<100与300~399)=8.913,P<_(100与300~399)=0.003;χ^(2)_(<100与400~499)=7.545,P_(<100与400~499)=0.006;χ^(2)_(<100与≥500)=10.940,P_(<100与≥500)=0.001)。对HBsAg(-)人群分析发现不仅CD4细胞是HBsAb(+)的影响因素,同时发现HBeAb(+)和乙肝核心抗体(HBcAb)(+)人群中HBsAb阳性率也较高(OR_(HBeAb(+))=3.241,P_(HBeAb(+))<0.001;OR_(HBcAb(+))=1.380,P_(HBcAb(+))<0.001)。结论HIV感染者CD4细胞水平影响HBV血清标志物抗体的表达,为HIV感染者HBV的防控提供理论依据。

Objective To have a retrospective analysis of the test results of hepatitis B virus serum markers in 4336 newly diagnosed patients with HIV,who were treated in the outpatient department of Chongqing Public Health Medical Center from January 2016 to June 2019,to study the effect of immune level on serum markers of hepatitis B virus and their correlation.Methods The outpatient electronic system was used to extract relevant information and data of the patients during the period,followed by the retrospective analysis of demographic data,immunology,and hepatitis B virus serum markers.Results Among 4336 HIV cases,the positive rate of HBeAb in different CD4 levels in HBsAg positive group was statistically significant(χ^(2)=14.064,P=0.015).Further pairwise comparisons showed that when CD4 count was<300 cells/μL,HBeAb positive rate was lower with the difference statistically significant(χ^(2)_(<100 and 200-299)=12.414,P_(<100 and 200-299)<0.001),(χ^(2)_(100-199 and 200-299)=6.268,P_(100-199 and 200-299)=0.012);and the positive rate of HBeAb in the HB sAg(+)group increased with the increase of CD4 level(χ^(2)=6.594,P=0.010),and CD4 and age(OR>1,P<0.001)were the influencing factors of HBeAb(+),and HBeAb positive rate increased with the increase of age.There was a statistically significant difference in the HBsAb positive rate of different CD4 levels among the HBsAg(-)group(χ^(2)=22.80,P<0.001),and the HBsAb(+)positive rate decreased with the decrease of CD4.Pairwise comparison found that when CD4 count was≥300 cells/ul,each group had a higher positive rate than the CD4<100 cells/ul group,with the difference statistically significant(χ^(2)<_(100 and 300-399)=8.913,P<_(100 and 300-399)=0.003;χ^(2)<_(100 and 400-499)=7.545,P<_(100 and 400-499)=0.006;χ^(2)<_(100 and≥500)=10.940,P<_(100 and≥500)=0.001).The analysis of HBsAg(-)group found that not only CD4 was an influencing factor of HBsAb(+),but also the HBeAb(+)and HBcAb(+)groups had higher HBsAb positive rate(OR_(HBeAb(+))=3.241,P_(HBeAb(+))<0.001;OR_(HBcAb(+))=1.380,PH_(BcAb(+))<0.001).Conclusion CD4^(+)T lymphocytes levels in HIV-infected people affect the expression of HBV serum marker antibodies,and provide a theoretical basis for the prevention and control of HBV in HIV-infected people.