2527例乙肝患者HBV-DNA定量检测与其血清标志物的相关性研究

Correlation between HBV-DNA quantitative detection and serum markers in 2527 patients with hepatitis B

目的 探讨外周血乙肝病毒脱氧核糖核酸(HBV-DNA)定量检测与其乙肝血清标志物(HBV-M)的相关性。方法选取2019年1月-2020年12月于重庆市第五人民医院就诊的2 527例乙肝两对半检测中HBV表面抗原(HBsAg)为阳性的患者作为研究对象,进行HBV-DNA及HBV-M的检测,并对检测结果进行统计分析。结果 研究对象HBV-DNA低拷贝组“小三阳”检出率(89.38%)高于高拷贝组(48.44%);高拷贝组“大三阳”检出率(48.68%)高于低拷贝组(4.08%),差异均有统计学意义(均P <0.001)。在HBsAg和HBV核心抗体(HBcAb)同时阳性的患者中,HBV e抗原(HBeAg)无论存在与否,均可出现HBV-DNA复制。HBV-DNA检出率随着HBsAg、HBeAg浓度的升高而增加,HBV-DNA拷贝数与HBsAg浓度呈正相关,但关系不密切(r=0.210,P <0.001);HBV-DNA拷贝数与HBeAg浓度无相关性(r=0.170,P=0.093)。研究对象HBV-DNA检出率(63.55%)明显高于HBeAg检出率(11.67%),差异有统计学意义(P <0.001)。以HBV-DNA的检出作为HBV复制的金标准来评价HBeAg,HBeAg检测的灵敏度、特异度,阴、阳性预测值分别为16.19%、96.20%、39.70%及88.14%,在HBeAg阴性组中以HBV-DNA低拷贝检出为主(90.49%),在HBeAg阳性组中以HBV-DNA高拷贝检出为主(69.49%),差异有统计学意义(P <0.001)。结论 HBV-DNA和HBV-M定量检测二者独立又互补,应联合检测减少漏检率,以指导实施更科学的治疗方案。

Objective To investigate the correlation between quantitative detection of hepatitis B virus deoxyribonucleic acid(HBV-DNA)in peripheral blood and hepatitis B virus markers(HBV-M).Methods A total of 2527 patients with positive Hepatitis B surface antigen(HBsAg)in hepatitis B serologic testing who visited the Fifth People’s Hospital of Chongqing from January 2019 to December 2020 were selected as the study subjects for HBV-DNA and HBV-M detection.The detection results were statistically analyzed.Results The detection rate of positive HbsAg,anti-HBe,and antiHBc in the HBVDNA low copy group(89.38%)was higher than that in the high copy group(48.44%);and the detection rate of positive HBsAg,HBeAg,and Anti-HBc in the high copy group(48.68%)was higher than that in the low copy group(4.08%),with statistically significant.differences(both P<0.001).In patients with both positive HBsAg and hepatitis B core antibody(HBcAb),HBV e antigen(HBeAg)replication of HBV-DNA can occur regardless of its presence or absence.The detection rate of HBV-DNA increased with the increase of HBsAg and HBeAg concentrations,and the HBV-DNA copy number was positively correlated with HBsAg concentration,but not closely related(r=0.210,P<0.001).The HBV-DNA copy number was not correlated with HBeAg concentration(r=0.170,P=0.093).The detection rate of HBV-DNA(63.55%)was significantly higher than that of HBeAg(11.67%)(P<0.001).The sensitivity and specificity of HBeAg detection were evaluated by the detection of HBV-DNA as the gold standard for HBV replication,and the negative and positive predictive values were 16.19%,96.20%,39.70%and 88.14%,respectively,which were mainly detected by a low copy of HBV-DNA in the HBeAg-negative group(90.50%)and a high copy of HBV-DNA in the HBeAg-positive group(69.49%),and the difference was statistically significant(P<0.001).Conclusion HBV-DNA and HBV-M quantitative detection are independent and complementary,and combined detection can reduce the missed detection rate to guide the implementation of more scientific treatment protocols.