HBcrAg、HBsAg对CHB患者肝组织炎症程度和纤维化程度的预测价值

The Predictive Value of HBcrAg and HBsAg on the Degree of Liver Inflammation and Fibrosis in Patients with CHB

目的分析慢性乙型肝炎(chronic hepatitis B,CHB)患者治疗前肝炎核心相关抗原(hepatitis B core-related antigen,HBcrAg)与乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)对肝组织炎症程度与纤维化程度的预测价值,及采用恩替卡韦治疗后不同炎症程度与纤维化程度HBcrAg、HBsAg变化情况。方法回顾性分析我院2018年12月至2020年1月收治的CHB患者150例作为研究对象。根据其肝脏活检结果对其肝组织炎症程度与纤维化程度进行划分,采用受试者操作特征曲线(receiver operating characteristic curve,ROC)分析HBcrAg、HBsAg对肝脏炎症程度及纤维化程度的预测价值。所有患者均接受恩替卡韦治疗,观察不同炎症程度与纤维化程度患者治疗前、治疗12周、24周、48周时HBcrAg、HBsAg变化。结果根据广义估计方程分析显示,不同炎症程度及不同纤维化患者在组别及时点因素中,差异具有统计学意义(P<0.05)。其中治疗48周时HBcrAg、HBsAg水平显著低于治疗前、治疗12周、治疗24周,差异具有统计学意义(P<0.05);治疗24周显著低于治疗12周、治疗前,差异具有统计学意义(P<0.05);治疗12周显著低于治疗前,差异具有统计学意义(P<0.05)。ROC曲线分析显示,HBcrAg、HBsAg预测G3患者的AUC分别为0.653、0.757;两项联合预测G3患者的AUC为0.879;HBcrAg、HBsAg预测S3患者的AUC分别为0.669、0.647;两项项联合预测S3患者的AUC为0.824。结论CHB患者接受恩替卡韦治疗后HBcrAg、HBsAg表达水平显著下降。HBcrAg、HBsAg对预测CHB患者肝组织炎症程度与肝纤维化程度具有一定价值。

Objective To analyze the relationship between hepatitis B core related antigen(HBcrAg)and hepatitis B surface antigen(HBsAg)in patients with chronic hepatitis B(CHB)before treatment and the predictive value of HBsAg for the degree of inflammation and fibrosis of liver tissue,and the changes of HBcrAg and HBsAg in different degrees of inflammation and fibrosis after entecavir treatment.Methods 150 patients with CHB in our hospital from December,2018 to January,2020 were retrospectively analyzed.According to the results of liver biopsy,the degree of liver inflammation and fibrosis were used to divide patients,and the predictive value of HBcrAg and HBsAg on the degree of liver inflammation and fibrosis was analyzed by receiver operating characteristic curve(ROC).All patients were treated with entecavir.The changes of HBcrAg and HBsAg were observed before treatment,12 weeks,24 weeks and 48 weeks after treatment.Results According to the analysis of the generalized estimation equation,the difference in the group and time point factors of patients with different inflammation degrees and different fibrosis was statistically significant(P<0.05).Levels of HBcrAg and HBsAg at 48 weeks of treatment were significantly lower than before treatment,12 weeks of treatment,and 24 weeks of treatment(P<0.05),and the level of treatment at 24 weeks was significantly lower than that at 12 weeks and before treatment(P<0.05);12 weeks of treatment was significantly lower than before treatment(P<0.05).ROC curve analysis showed that HBcrAg and HBsAg predicting G3 patients had the AUC of 0.653 and 0.757,respectively,while the two-marker joint prediction had the AUC of 0.879;HBcrAg and HBsAg predicting S3 patients had the AUC of 0.669 and 0.647,respectively,while the two-marker joint prediction had the AUC of 0.824.Conclusion After entecavir treatment,the expression of HBcrAg and HBsAg in CHB patients decrease significantly.HBcrAg and HBsAg have a certain value in predicting the degree of liver inflammation and liver fibrosis in CHB patients.