乙肝表面抗原和表面抗体同时阳性对乙肝性肝癌的预测价值

Predictive value of simultaneous hepatitis B surface antigen and antibody positivity for hepatitis B-related liver cancer

目的研究乙型病毒性肝炎(乙肝)表面抗原(HBsAg)和乙肝表面抗体(抗-HBs)同时阳性对乙肝性肝癌的预测价值。方法回顾性分析2016~2018年在永泰县医院就诊的乙肝患者,通过电化学发光免疫分析法(ECLIA)检测患者的乙型肝炎病毒(HBV)血清标志物,共发现HBsAg3569份阳性样本,其中HBsAg和抗-HBs同时阳性的患者261例,仅HBsAg阳性患者3308例,经过4~5年的病情演变,HBsAg和抗-HBs同时阳性的患者中有25例发展为肝癌(病例组),仅HBsAg阳性患者中有165例发展为肝癌(对照组)。比较HBsAg阳性与HBsAg和抗-HBs同时阳性患者的相关指标[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、HBsAg、HBV-DNA、肝癌发生率]及肝癌与非肝癌患者的临床资料。结果HBsAg阳性与HBsAg和抗-HBs同时阳性患者TBIL、ALT比较,差异无统计学意义(P>0.05);HBsAg和抗-HBs同时阳性患者HBsAg(2845.7±2822.6)COI、HBV-DNA(2.62±1.85)IU/ml低于HBsAg阳性患者的(5851.5±1937.4)COI、(3.61±1.65)IU/ml,肝癌发生率9.57%高于HBsAg阳性患者的4.98%,差异均有统计学意义(P<0.05)。肝癌患者男性、年龄>40岁、HBsAg和抗-HBs同时阳性占比分别为86%、96%、13%,高于非肝癌患者的63%、68%、5%,差异有统计学意义(P<0.05)。肝癌与非肝癌患者的HBV-DNA比较差异无统计学意(P>0.05)。结论乙肝HBsAg和抗-HBs同时阳性可增加患肝癌的风险。

Objective To study the predictive value of simultaneous hepatitis B surface antigen(HBsAg)and antibody(anti-HBs)positivity in patients with hepatitis B-related liver cancer.Methods A retrospective analysis of hepatitis B patients treated in Yongtai County Hospital from 2016 to 2018 and detection of hepatitis B virus(HBV)serum markers in patients by electrochemiluminescence immunoassay(ECLIA)revealed 3569 positive samples for HBsAg,among which 261 patients were positive for both HBsAg and anti-HBs and 3308 patients were positive for HBsAg only.After 4-5 years of disease evolution,25 patients with simultaneous positivity for HBsAg and anti-HBs developed liver cancer(case group)and 165 patients with HBsAg positivity developed liver cancer(control group).The relevant indicators[alanine aminotransferase(ALT)and total bilirubin(TBIL),HBsAg,hepatitis B virus(HBV)-DNA,incidence of liver cancer]between patients with HBsAg positivity and patients with simultaneous HBsAg and anti-HBs positivity were compared,as well as the clinical data of patients with and without liver cancer.Results There was no statistically significant differences in TBIL and ALT between patients with HBsAg positivity and patients with simultaneous HBsAg and anti-HBs positivity(P>0.05).HBsAg of(2845.7±2822.6)and HBV-DNA of(2.62±1.85)in patients with simultaneous HBsAg and anti-HBs positivity were lower than those of(5851.5±1937.4)and(3.61±1.65)in patients with HBsAg positivity;the incidence of liver cancer was 9.57% in patients with simultaneous HBsAg and anti-HBs positivity,which was higher than that of 4.98% in patients with HBsAg positivity;all differences were statistically significant(P<0.05).The percentages of male,age>40 years,and simultaneous HBsAg and anti-HBs positivity in patients with liver cancer were 86%,96%,and 13%,which were higher than 63%,68%,and 5% in patients without liver cancer,and the differences were statistically significant(P<0.05).Conclusion Simultaneous HBsAg and anti-HBs positivity positive can increase the risk of liver cancer.