慢性HBV感染者血清HBV pgRNA、HBV-LP表达与肝脏纤维化程度的相关性研究

Correlation between the expressions of HBV pgRNA and HBV-LP in serum and the degree of liver fibrosis in patients with chronic HBV infection

目的探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者血清HBV前基因组RNA(HBV pregenomic RNA,HBV pgRNA)、HBV外膜大蛋白(HBV large surface protein,HBV-LP)水平与肝脏纤维化程度的关系。方法选取本院收治的182例行肝组织活检的慢性HBV感染者为研究对象。检测血清HBV pgRNA、HBV-LP、谷丙转氨酶(alanine aminotransferas,ALT)、谷草转氨酶(aspartate aminotransferase,AST)水平及肝脏硬度值(liver stiffness measurement,LSM)。使用受试者工作特征曲线(receiver operator characteristic curves,ROC)评估血清HBV pgRNA、HBV-LP水平对慢性HBV感染者肝纤维化的诊断价值。结果与无纤维化组比较,轻中度、重度纤维化组患者血清HBV pgRNA水平均降低(P<0.05),HBV-LP、ALT、AST及LSM水平升高(P<0.05),且随肝纤维化程度加重,慢性HBV感染者血清HBV pgRNA水平呈降低趋势,HBV-LP、ALT、AST及LSM水平呈升高趋势。血清HBV-LP水平与ALT、AST、LSM均呈正相关(P<0.05)。血清HBV pgRNA、HBV-LP诊断慢性HBV感染者肝纤维化的曲线下面积(area under the cure,AUC)为0.828、0.833,相应灵敏度为82.0%、82.1%,特异度为75.0%、75.0%;两者联合诊断的AUC为0.917,其灵敏度、特异度为78.4%、95.0%。结论发生肝纤维化的慢性HBV感染者血清HBV pgRNA水平降低,HBV-LP水平升高,两者联合可有效诊断慢性HBV感染者肝纤维化及评估纤维化程度。

Objective To investigate the relationships between serum hepatitis B virus pregenomic RNA(HBV pgRNA),hepatitis B virus large surface protein(HBV-LP)levels and liver fibrosis in patients with chronic hepatitis B virus(HBV)infection.Methods A total of 182 patients with chronic HBV infection receiving liver biopsy in our hospital were selected as the research subjects.The tests for serum levels of HBV pgRNA,HBV-LP,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and liver stiffness measurement(LSM)were performed.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic values of serum HBV pgRNA and HBV-LP levels in patients with chronic HBV infection.Results Compared with those in the non-fibrosis group,the levels of serum HBV pgRNA in mild to moderate fibrosis group and severe fibrosis group decreased(P<0.05),and the levels of HBV-LP,ALT,AST and LSM increased(P<0.05).Along with the progression of liver fibrosis,the level of serum HBV pgRNA decreased,and the levels of HBV-LP,ALT,AST and LSM increased.The level of serum HBV-LP was positively correlated with ALT,AST and LSM(P<0.05).The areas under the curve(AUC)of serum HBV pgRNA and HBV-LP in the diagnosis of liver fibrosis in patients with chronic HBV infection were 0.828 and 0.833,respectively;with the corresponding sensitivity of 82.0%and 82.1%,and the specificity of 75.0%and 75.0%,respectively.The AUC of combined diagnosis was 0.917 and the sensitivity and specificity were 78.4%and 95.0%,respectively.Conclusions In chronic HBV infected patients with liver fibrosis,the level of serum HBV pgRNA decreased,while the level of HBV-LP increased.The combination of the two criteria can effectively diagnose liver fibrosis and evaluate the degree of liver fibrosis among patients with chronic HBV infection.