慢性HBV感染不同状态下HBsAg定量的临床意义

Clinical Implications of HBs Ag Quantitation Under Different Conditions of Chronic HBV Infection

目的探讨HBs Ag定量在慢性HBV感染自然史的不同阶段及HBV相关肝硬化中的临床意义。方法纳入慢性HBV感染患者185例,其中无肝硬化患者根据自然史分为免疫耐受组(n=34)、HBe Ag阳性慢性乙型肝炎(chronic hepatitis B,CHB)组(n=25)、非活动携带组(n=24)及HBe Ag阴性CHB组(n=34),肝硬化患者分为HBe Ag阳性组(n=33)及HBe Ag阴性组(n=35)。检测患者血清HBs Ag、HBV DNA、ALT等指标。结果无肝硬化的慢性HBV感染患者HBs Ag水平由高到低为:免疫耐受组[(4.60±0.32)log10IU/ml)]、HBe Ag阳性CHB组[(4.36±0.45)log10IU/ml]、非活动携带组[(3.51±0.30)log10IU/ml]、HBe Ag阴性CHB组[(3.62±0.35)log10IU/ml]。无肝硬化患者,年龄与HBs Ag水平呈负相关(P=0.000);ALT与HBs Ag水平无相关性(P=0.152)。免疫耐受及HBe Ag阳性CHB组HBs Ag水平与HBV DNA呈正相关(P=0.000,P=0.009)。HBe Ag阳性肝硬化患者HBs Ag水平[(4.27±1.33)log10IU/ml]与HBe Ag阴性患者[(3.81±1.07)log10IU/ml]相似,HBs Ag与年龄及ALT无相关性(P>0.05)。结论 HBs Ag水平在HBe Ag阳性患者中可反映HBV DNA复制情况。无论有无肝硬化存在,HBs Ag水平都不能反映肝组织炎性情况。

Objective To investigate the clinical implications of HBs Ag quantitation in the natural history of chronic HBV infection and HBV-related cirrhosis.Methods A total of 185 patients with chronic HBV infection were included.Patients without cirrhosis were divided into the immune tolerance group( n = 34),HBe Ag-positive chronic hepatitis B( chronic hepatitis B,CHB) group( n = 25),inactive carrier group( n = 24) and HBe Ag-negative CHB group( n = 34); patients with cirrhosis were divided to HBe Ag-positive( n =33) and HBe Ag-negative groups( n = 35).We detected serum HBs Ag,HBV DNA,ALT and other indicators.Results For patients without cirrhosis,HBs Ag levels were( 4.60 ± 0.32) log10 IU / ml in immune tolerance group,( 4.36 ± 0.45) log10 IU / ml in HBe Ag-positive CHB group,( 3.51 ± 0.30) log10 IU / ml in the inactive carries group,and( 3.62 ± 0.35) log10 IU / ml in HBe Ag-negative CHB group.For patients without cirrhosis,their age was correlated with HBs Ag level( P = 0.000),but no correlation existed between ALT and HBs Ag( P = 0.152).HBs Ag levels of immune tolerance and HBe Ag-positive CHB groups were correlated with HBV DNA levels( P =0.000,P = 0.009).HBs Ag levels of HBe Ag-positive( 4.27 ± 1.33) log10 IU / ml and HBe Ag-negative( 3.81 ± 1.07) log10 IU / ml groups were similar in cirrhotic patients,and HBs Ag was not correlated with age or ALT( P > 0.05).Conclusion HBs Ag level in HBe Ag-positive patients may reflect HBV DNA replication.In patients with or without cirrhosis,HBs Ag can not reflect the inflammation of the liver.