HBcAb水平预测HBeAg阳性慢性乙肝初治患者肝纤维化程度的研究

Relationship between hepatitis B core antibody and liver fibrosis severity in CHB patients

目的探讨慢性乙型病毒性肝炎患者血清HBcAb水平与肝脏纤维化程度之间的关系。方法收集2015年1月—2017年2月郑州大学人民医院收治的436例进行肝穿刺活检的慢乙肝初治患者,分别采用雅培I2000和M2000检测HBsAg、HBeAg/HBeAb、HBcAb和HBV DNA水平;分析HBcAb水平等临床指标与肝组织纤维化程度的相关性。结果随着肝纤维化程度的逐渐加重,HBcAb水平逐渐升高,各组间差异存在统计学意义(F=4.664,P=0.003);在HBeAg阳性患者中,单因素Logistic回归结果显示,肝硬度值、ALT、AST、HBcAb、HBsAg和HBV DNA水平与肝脏纤维化程度显著相关(P<0.05);多因素Logistic回归结果显示,肝硬度值、HBcAb、HBsAg和HBV DNA水平与肝脏纤维化程度显著相关(P<0.05)。ROC曲线结果显示:HBcAb>10(S/CO)为截断值时,预测肝纤维化S2～S4的敏感性为72.9%,特异度为52.63%,曲线下面积(AUC)值为0.72。结论本研究结果表明,HBeAg(+)慢乙肝初治患者,HBcAb水平与肝脏中重度纤维化程度(S2～S4)显著相关,HBcAb>10(S/CO)可作为预测S2～S4的截断值,从而使患者避免进行肝穿刺,具有很好的临床应用价值。

Objective To explore the correlation between serum hepatitis B core antibody(HBcAb) level and hepatic tissue pathological staging in patients with chronic hepatitis B(CHB). Methods A total of 436 CHB patients who had undergone hepatic biopsy were collected from our hospital. The HBsAg, HBeAg/HBeAb, HBcAb and HBV DNA level were measured using I2000 and M2000 of Abbott. Correlation between serum HBcAb and degree of fibrosis was assessed statistically. Results As the severity of liver fibrosis increased, the HBcAb level gradually increased, and the differences were significant between the groups(F=4.664, P=0.003). Logistic regression analysis showed that the level of HBcAb was an independent prognostic factor of moderate to severe liver fibrosis, with fibroscan score, ALT, AST, HBsAg and HBV DNA level(P<0.05). Multiple logistic regression analysis showed that HBcAb, fibroscan score, HBsAg and HBV DNA level was correlated with moderate to severe liver fibrosis(P<0.05). ROC analysis suggested that a serum HBcAb cutoff of 10(S/CO) would provide a theoretical sensitivity of 72.9% and with theoretical specificity of 52.63% in HBeAg(+) CHB patients, and the AUC is 0.72. Conclusion HBcAb levels increase gradually along with aggravation of liver fibrosis(S2-S4). The cutoff values of 10(S/CO) for HBcAb predicts the degree of liver fibrosis in HBeAg-positive CHB patients, and is worthy of clinical application.