前S1蛋白在乙型肝炎诊断及判断预后中的作用

Hepatitis B Virus-preS1 Protein plays an important role in hepatitis B diagnosis and prognosis

目的 了解前S1蛋白 (PreS1)与乙型肝炎病毒 (HBV)复制的关系 ,及诊断乙型肝炎的价值。方法 采用酶联免疫吸附试验 (ELISA)方法对 32 4 3例携带乙型肝炎不同病毒标志物的慢性乙型肝炎患者血清进行PreS1测定并与HBVDNA做对比分析。检测 5 8例急性发病的经肝活检病理诊断为慢性乙型肝炎患者的血清 ,分析其不同病程的PreS1,HBeAg和HBVDNA三者间的关系。根据肝活检病理的肝组织炎症情况分为G1～G4级 ,对 4 9例PreS1和HBVDNA阳性病例进行分析比较。检测 39例不同病程急性乙型肝炎患者血清 ,分析PreS1和HBVDNA与丙氨酸氨基转移酶 (ALT)间的关系。结果 乙型肝炎病毒表面抗原 (HBsAg)、乙型肝炎病毒e抗原(HBeAg)、乙型肝炎病毒核心抗体 (HBcAb)阳性组与PreS1和HBVDNA符合率分别为 86 %和 88% ,P >0 .0 5 ,不同病程慢性乙型肝炎患者血清PreS1、HBeAg和HBVDNA检出率高度符合。HBsAg抗HBe抗HBc阳性组与PreS1和HBVDNA符合率分别为 36 %和 35 % ,说明部分HBeAg阴性患者仍有病毒复制。不同病程急性乙型肝炎患者血清PreS1和HBVDNA与ALT之间的关系 ,PreS1与ALT相比符合率高 ,P >0 .0 5。HBVDNA与ALT相比符合率较低 ,P <0 .0 1。病理肝组织G1～G4炎症分级与PreS1和HBVDNA高度吻合。

Objective To investigate the role of Hepatitis B Virus-preS1 Protein (HBV-preS1) in detecting the replication of virus and predicting the prognosis of hepatitis B. Methods 1. Using ELISA method, blood samples of 3243 chronic hepatitis B patients with different serum models were analyzed about preS1 and HBV DNA comparatively. 2. The dynamic association between preS1, HbeAg, and HBV DNA in different course of disease was investigated in 58 chronic hepatitis B patients with an acute episode diagnosed by liver biopsy. 3. Liver inflammation was classified into four grades (G1 to G4) by biopsy. Samples (49 preS1 positive cases and 49 HBV DNA positive cases) were analyzed and compared. 4. Plasma preS1 and HBV DNA were detected in 39 acute cases of different course, and the correlation between the two markers and ALT was analyzed. Results In chronic hepatitis B patients, for those whose serum HBsAg, HBeAg and HBcAb were positive, the rates between preS1, HBV DNA and the traditional Ag-Ab detection were 86% and 88% separately (P<0.05). In different course of chronic cases, the results of preS1, HBeAg and HBV DNA detection coincided greatly (P>0.05). As for those whose serum HBsAg, HBeAb, and HBcAb were positive, the coincidence rates of preS1 and HBV DNA were 36% and 35% separately. This indicated that though HBeAg had become negative, HBV still replicated in some patients. In different course of acute hepatitis B cases, the results of preS1 and ALT detection coincided greatly (P>0.05), while those of HBV DNA and ALT coincided poorly (P<0.01). An identical association was also found between preS1, HBV DNA and liver G1 to G4 inflammatory classification. Conclusion preS1can reflect the replication of HBV sensitively, especially for those who are HBeAg-negative. In acute hepatitis B patients, preS1 became negative earlier than HBV DNA, which suggested a good prognosis of disease.