HBsAg和HBV DNA定量水平在慢性HBV感染自然史中的变化

Changes in Quantitative HBsAg and HBV DNA Levels in the Natural History of Chronic HBV Infection

目的:探讨慢性乙型肝炎(CHB)患者HBsAg和HBV DNA定量的变化及两者的相关性。方法:选择2015年4月—2020年8月武警特色医学中心收治的144例慢性HBV感染患者,其中根据自然史分为免疫耐受期(IT)(n=46)、免疫清除期(IC)(n=28)、低复制期(LR)(n=24)、再活动期(RA)(n=46)。分别采用化学发光定量法和实时荧光定量PCR法检测患者血清HBsAg和HBV DNA。结果:CHB患者不同时期HBsAg和HBV DNA定量水平差异均有统计学意义(P<0.05),HBsAg和HBV DNA在IT期显著高于其他3期,LR期最低(P<0.05)。HBsAg和HBV DNA定量在IC期(r=0.3873,P<0.05)和RA期具有相关性(r=0.7401,P<0.05)。ROC曲线分析显示:HBsAg>3.455 log10 IU/mL的截断值(2852 IU/mL),用于预测IC期敏感度为78.60%,特异度为79.10%;HBsAg>3.505 log10 IU/mL的截断值(3200 IU/mL),用于预测RA期敏感度为74.31%,特异度为80.21%。结论:CHB自然史不同阶段HBsAg和HBV DNA水平有明显差异,但仅在IC期和RA期HBsAg与HBV DNA相关。这些发现表明HBsAg(3200 IU/mL)作为预测HBV再激活有重要价值。

Objective:To investigate the changes of HBsAg and HBV DNA quantification in patients with chronic hepatitis B(CHB)and the correlation between them.Methods:A total of 144 patients with chronic HBV infection admitted to the center from April 2015 to August 2020 were selected and classified into immune tolerance phase(IT,n=46),immune clearance phase(IC,n=28),low-replication phase(LR,n=24),and reactivation phase(RA,n=46)according to their natural history.The patients’serum HBsAg and HBV DNA were detected by chemiluminescence quantitative method and real-time fluorescence quantitative PCR method,respectively.Results:There was a statistically significant difference in the quantitative levels of HBsAg and HBV DNA in CHB patients at different periods(P<0.05).HBsAg and HBV DNA were significantly higher in the IT stage and lowest in the LR stage than in the other 3 stages,with statistically significant differences(P<0.05).HBsAg and HBV DNA quantification were correlated in the IC(r=0.3873,P<0.05)and RA stages(r=0.7401,P<0.05).ROC curve analysis showed a cut-off value of 2852 IU/mL for HBsAg>3.455 log10 IU/mL,which was used to predict the IC phase with a sensitivity of 78.60%and a specificity of 79.10%.A cut-off value of HBsAg>3.505 log10 IU/ml(3200 IU/mL)was used to predict the RA stage with a sensitivity of 74.31%and a specificity of 80.21%.Conclusion:HBsAg and HBV DNA levels differed significantly at different stages of the natural history of CHB,but HBsAg correlated with HBV DNA only at the IC and RA stages,indicating that HBsAg(3200 IU/mL)has significant value as a predictor of HBV reactivation.