Detection of hepatitis C virus core antigen for early diagnosis of hepatitis C virus infection in plasma donor in China

AIM: To evaluate the effi cacy of a new hepatitis C virus (HCV) core antigen assay developed in China. METHODS: After the determination of HCV infection, 49 serial samples were selected from 11 regular plasma donors in 5 different plasma stations. To compare the performance of HCV core antigen detection and HCV PCR, these samples were genotyped, and each specimen was analyzed by ELISA for the detection of HCV core antigen and by qualitative HCV PCR. RESULTS: Among all of the sequential samples, the original 13 specimens were HCV RNA-negative, and 36 samples were HCV RNA-positive. Twenty-seven samples (75%) were HCV core antigen-positive from these HCV RNA-positive specimens. Conversely, 27 samples (93.1%) were found HCV RNA-positive in HCV core antigen-positive samples. Intervals between HCV RNA and HCV core antigen-positive, as well as between HCV core antigen-positive and HCV antibody-positive were 36.0 and 32.8 d, respectively. CONCLUSION: This HCV core antigen assay, developed in China, is able to detect much of anti-HCV-negative, HCV RNA-positive preseroconversion window period (PWP) plasma donations.

Enhancement of CTLs induced by DCs loaded with ubiquitinated hepatitis B virus core antigen

AIM:To investigate whether hepatitis B virus (HBV) could induce a hepatitis B virus core antigen (HBcAg)specific cytotoxic T lymphocyte (CTL) response in vitro by dendritic cells (DCs) transduced with lentiviral vector-encoding ubiquitinated hepatitis B virus core antigen (LV-Ub-HBcAg).METHODS:Recombinant LV-Ub-HBcAg were transfected into highly susceptible 293 T cells to obtain high virus titres.Bone marrow-derived DCs isolated from BALB/c mice were cultured with recombinant granulocyte-macrophage colony-stimulating factor and recombinant interleukin (IL)-4.LV-Ub-HBcAg,lentiviral vector-encoding hepatitis B virus core antigen (LV-HBcAg),lentiviral vector (LV) or lipopolysaccharide were added to induce DC maturation,and the DC phenotypes were analyzed by flow cytometry.The level of IL-12 in the supernatant was detected by enzyme-linked immunosorbent assay (ELISA).T lymphocytes were proliferated using Cell Counting Kit-8.DCs were cultured and induced to mature using different LVs,and co-cultured with allogeneic T cells to detect the secretion levels of IL-2,IL-4,IL-10 and interferon-γ in the supernatants of T cells by ELISA.Intracellular cytokines of proliferative T cells were analyzed by flow cytometry,and specific CTL activity was measured by a lactate dehydrogenase release assay.RESULTS:LV-Ub-HBcAg-induced DCs secreted more IL-12 and upregulated the expression of CD80,CD86 and major histocompatibility class Ⅱ.DCs sensitised by different LVs effectively promoted cytokine secretion;the levels of IL-2 and interferon-γ induced by LV-UbHBcAg were higher than those induced by LV-HBcAg.Compared with LV-HBcAg-transduced DCs,LV-UbHBcAg-transduced DCs more efficiently stimulated the proliferation of T lymphocytes and generated HBcAgspecific cytotoxic T lymphocytes.CONCLUSION:LV-Ub-HBcAg effectively induced DC maturation.The mature DCs efficiently induced T cell polarisation to Th1 and generated HBcAg-specific CTLs.

Hepatitis C virus core antigen testing: Role in diagnosis, disease monitoring and treatment

While hepatitis B virus(HBV)screening relies on hepatitis B surface antigen to confirm HBV infection since the early days of hepatitis B disease management,hepatitis C virus(HCV)infection screening is based on anti-HCV testing which does not discriminate active from past infection.Thus to confirm infection HCV RNA testing has been required;recently a HCV core antigen assay became widely commercially available which could serve to confirm infection.That assay is less sensitive than current HCV RNA assays,but as more than 50%of anti-HCV positive persons will be HCV core antigen positive,HCV core antigen testing can be a cost effective and reflex test to confirm HCV infection in anti-HCV positive individuals and will be easier as it can be applied on the same platform.For treatment monitoring,more data need to be generated,but the early data available at present suggest that HCV core antigen may be an alternative to HCV RNA monitoring.With direct antivirals,HCV core antigen could even be superior to HCV RNA testing,as direct antivirals might already prevent virus formation when HCV core antigen is still produced and thereby correlates better with eventual viral clearance.

Serum hepatitis B core-related antigen as a surrogate marker of hepatitis B e antigen seroconversion in chronic hepatitis B

BACKGROUND Quantitative hepatitis B core-related antigen(qHBcrAg)has a better correlation with intrahepatic hepatitis B virus(HBV)covalently closed circular DNA(cccDNA)than HBV DNA or hepatitis B e antigen(HBeAg),but data are still lacking for its clinical application.AIM The aim was to investigate serum qHBcrAg levels in patients with chronic hepatitis B and assess the correlation of serum qHBcrAg with pregenomic RNA(pgRNA),cccDNA,and HBeAg seroconversion.METHODS This study was a secondary analysis of patients who underwent percutaneous liver biopsy between July 2014 and June 2019 in two multicenter randomized controlled clinical trials of peginterferon vs nucleos(t)ide analog(NUC)-based therapy(NCT03509688 and NCT03546530).Serum qHBcrAg,pgRNA,HBV DNA,hepatitis B core antigen,HBeAg,liver cccDNA,and HBV DNA were measured.The correlations of serum qHBcrAg with other biomarkers were analyzed.RESULTS A total of 139 patients were included.The mean qHBcrAg levels were 5.32±1.18 log10 U/mL at baseline and decreased during treatment(all P<0.0001).Serum qHBcrAg levels were positively correlated with pgRNA(r=0.597,P<0.0001)and cccDNA(r=0.527,P<0.0001)levels.The correlation of serum qHBcrAg level and intrahepatic HBV DNA levels at baseline was weak but significant(r=0.399,P<0.0001).HBcrAg predicted HBeAg seroconversion,with areas under the receiver operating characteristics curve of 0.788 at 24 wk and 0.825 at 48 wk.Log HBcrAg at wk 24 and 48 was independently associated with HBeAg seroconversion[odds ratio(OR)=2.402,95%confidence interval(CI):1.314-4.391,P=0.004;OR=3.587,95%CI:1.315-9.784,P=0.013].CONCLUSION Serum HBcrAg levels were correlated with HBV virological markers and could be used to predict HBeAg seroconversion.

On-treatment monitoring of liver fibrosis with serum hepatitis B core-related antigen in chronic hepatitis B

BACKGROUND Non-invasive evaluation for liver fibrosis is clinically important,especially in patients with undetectable hepatitis B virus(HBV)DNA treated with nucleoside analogs.AIM To clarify the monitoring power of hepatitis B core-related antigen(HBcrAg)for hepatic histologic changes in patients with chronic hepatitis B(CHB)treated with entecavir.METHODS This prospective multicenter study used multiple ordinal and multivariate logistics regression analysis to assess variables associated with Ishak fibrosis score and regression for fibrosis regression,respectively,in 403 CHB patients,including 374 with entecavir for 72 weeks(291 underwent paired liver biopsy)and 29 as controls.RESULTS Level of HBcrAg correlated negatively with liver fibrosis staging(γ=-0.357,P<0.001)in hepatitis B e antigen(HBeAg)-positive patients,and positively with liver fibrosis staging in HBeAg-negative patients.Higher HBcrAg concentration was associated with younger age,HBeAg positive status,high HBV DNA loads,high level of hepatitis B surface antigen(HBsAg)and higher necroinflammation,but not with HBV genotype.Serum concentration of HBcrAg,basal core promoter/precore(BCP/PC)mutant,quantitation of HBsAg(qHBsAg)and platelet counts were independently associated with Ishak fibrosis score on multiple ordinal regression.HBV DNA was undetectable in 88.37%of patients treated with entecavir at week 72,while their level of HBcrAg was still detectable.A greater reduction in post-treatment HBcrAg concentration was associated with the regression of hepatic fibrosis and histological improvement.HBcrAg concentration>6.33 log IU/mL at baseline and logarithmic reduction>1.03 log IU/mL at week 72 were associated with a higher chance of regression of liver fibrosis and histological improvement,respectively.CONCLUSION HBcrAg level is associated with liver fibrosis progression.HBcrAg is an excellent monitor of hepatic histological changes,especially in CHB patients treated with nucleoside analogs.

Mutations of pre-core and basal core promoter before and after hepatitis B e antigen seroconversion

AIM: To investigate the role of pre-core and basal core promoter(BCP) mutations before and after hepatitis Be antigen(HBe Ag) seroconversion.METHODS: The proportion of pre-core(G1896A) and basal core promoter(A1762T and G1764A) mutant viruses and serum levels of hepatitis B virus(HBV) DNA, hepatitis B surface antigen(HBs Ag), and HB core-related antigen were analyzed in chronic hepatitis B patients before and after HBe Ag seroconversion(n = 25), in those who were persistently HBe Ag positive(n = 18), and in those who were persistently anti-HBe positive(n = 43). All patients were infected with HBV genotype C and were followed for a median of 9 years.RESULTS: Although the pre-core mutant became predominant(24% to 65%, P = 0.022) in the HBe Ag seroconversion group during follow-up, the proportion of the basal core promoter mutation did not change. Median HBV viral markers were significantly higher in patients without the mutations in an HBe Ag positive status(HBV DNA: P = 0.003; HBs Ag: P < 0.001; HB core-related antigen: P = 0.001). In contrast, HBV DNA(P = 0.012) and HBs Ag(P = 0.041) levels were significantly higher in patients with the pre-core mutation in an anti-HBe positive status.CONCLUSION: There is an opposite association of the pre-core mutation with viral load before and after HBe Ag seroconversion in patients with HBV infection.

Expression of human hepatitis C virus core antigen in tobacco plants by tobacco mosaic virus-based vector system

Tobacco mosaic virus (TMV) has the potential to highly express foreign gene. A novel TMV-based in trans expression system was constructed. A TMV mutant TSHc had its coat protein replaced with hepatitis C vir黶 (HCV) core antigen gene. Anotherr TMV mutant TSBD was repli-case-defective. Coinfection of the two mutants could cause systemic infection in tobacco plants by in trans complementation of their functions. TSHc could effectively replicate and assemble to viral particles, which were a little longer than that of wild-type TMV. HCV core antigen was expressed in whole tobacco plants. A similar expression level of HCV core antigen was detected on serial passages, which suggested that this viral expression system be stable.

Expression and characterization of hepatitis C virus core protein fused to hepatitis B virus core antigen

Recombinant plasmids were constructed by fusing the gene fragments encoding the full-length (1-191aa) and the truncated (1-40aa and 1-69aa) HCV core proteins (HCc) respectively to the core gene of HBV at the position of amino acid 144 and expressed in E. coli. The products were analyzed by ELISA, Western blotting as well as the immunization of the mice. The results showed that those fusion proteins (B144C191, B144C69, B144C40) possessed the dual antigenicity and immunogenicity of both hepatitis B virus core antigen (HBcAg) and hepatitis C virus core protein (HCc). Analysis by electron microscopy and CsCl density gradient ultra-centrifugation revealed that similar to the HBcAg itself, all fusion proteins were able to form particles. Comparison of the antigenicity and immunogenicity of those fusion proteins showed that the length of HCc gene fused to HBeAg had no much effect on the antigenicity and immunogenicity of HBcAg, however, B144C69 and B144C40 induced higher titres antibodies against HCc than

高敏丙型肝炎病毒核糖核酸在丙型肝炎中的诊断价值

目的比较高敏丙型肝炎病毒核糖核酸(HCV-RNA)与普通HCV-RNA、丙型肝炎病毒(HCV)核心抗原检测在丙型肝炎临床诊断中的优势,探讨高敏HCV-RNA在临床诊断和病情监测中的应用价值。方法选择48例HCV抗体阳性的门诊及住院患者作为观察组,另选择同期40例HCV抗体阴性的健康体检者作为对照组。采集所有研究对象5 mL空腹静脉血标本,留取血清。高敏HCV-RNA采用赛沛全自动医用聚合酶链反应(PCR)分析系统检测,普通HCV-RNA采用厦门安普利生物技术有限公司Anadas9850全自动核酸提纯系统及荧光定量PCR分析系统及配套试剂检测,HCV抗体及HCV核心抗原检测采用酶联免疫吸附试验。试验前,先对赛沛高敏HCV-RNA检测进行性能验证。结果高敏HCV-RNA检测性能验证准确度、重复性、线性范围和最低检出限符合要求。高敏HCV-RNA诊断丙型肝炎灵敏度明显高于普通HCV-RNA及HCV核心抗原检测。结论高敏HCV-RNA是丙型肝炎诊断的重要指标,并可用于丙型肝炎治疗终点判断和病情监测。

HCV的Core-NS3嵌合抗原在大肠杆菌中的表达、纯化及初步应用

用已经构建的含有HCV的Core-NS3(C33 c)嵌合基因的表达质粒pGEX TL1-2在大肠杆菌中进行了高效表达,表达产物纯化后通过SDS-PAGE、W estern-b lot、ELISA等一系列鉴定试验进行了分析,结果表明,该嵌合抗原具有高度特异性和良好的抗原活性,为研制诊断用HCV抗原奠定基础。

无锡地区HBsAg-/HBV DNA+献血人群HBcrAg检出特点分析

目的分析新型血清标志物乙型肝炎核心相关抗原(HBcrAg)在无锡地区HBsAg-/HBV DNA+献血人群中的检出特点。方法通过电话追踪随访了37名既往HBsAg-/HBV DNA+献血者并获得其血清,采用电化学发光法和实时荧光定量PCR核酸筛检出22例HBsAg-/HBV DNA+献血者血清作为OBI组进行HBcrAg酶联免疫吸附法检测。挑选出20名经2遍酶免和1遍核酸筛检的健康献血者的血清作为健康对照组,20例经无锡第五人民医院临床诊断为慢性乙型肝炎患者血清作为实验的CHB组,分别进行HBcrAg酶联免疫吸附法检测;并对OBI组进行HBcrAg与HBeAb、HBcAb、ALT、HBV DNA的相关性分析。结果37份献血者标本经化学发光法检测HBsAg和核酸筛查,检出22份HBsAg-/HBV DNA+标本即OBI组,检出率59.46%。OBI组与健康对照组、CHB组血清的HBcrAg表达含量分别是(0.92±0.13)ng/mL、(0.47±0.09)ng/mL、(1.14±0.23)ng/mL(P<0.05),OBI组与CHB组的HBcrAg表达均高于健康对照组(P<0.05)。OBI组的HBcrAg与HBeAb、HBcAb、ALT、HBV DNA指标均无相关性(P>0.05)。结论OBI组与CHB组的HBcrAg表达均高于健康对照组,其血清HBcrAg在一定程度上与HBeAb、HBcAb、ALT、HBV DNA无相关性,HBcrAg在筛查HBsAg-/HBV DNA+献血者中具有较好的应用前景。

Novel DNA vaccine based on hepatitis B virus core gene induces specific immune responses in Balb/c mice

AIM: To investigate the immunogenicity of a novel DNA vaccine,pSW3891/HBc, based on HBV core gene in Balb/c mice.METHODS: A novel DNA vaccine, pSW3891/HBc, encoding HBV core gene was constructed using a vector plasmid pSW3891. Balb/c mice were immunized with either pSW3891/HBc or empty vector DNA via gene gun. IgG anti-HBc responses in mouse sera were demonstrated by ELISA. Specific cytotoxicity of cytotoxic T lymphocytes (CTLs) of mice was quantitatively measured by lactate dehydrogenase release assay.RESULTS: HBcAg was expressed effectively in 293T cell line transiently transfected with pSW3891/HBc. Strong IgG anti-HBc responses were elicited in mice immunized with pSW3891/HBc. The end-point titers of anti-HBc reached the highest 1:97 200, 4 wk after the third immunization. The specific CTL killing with the highest specific lysis reached 73.25% at effector:target ratio of 20:1 in mice that received pSW3891/HBc DNA vaccine.CONCLUSION: pSW3891/HBc vaccination elicits specific anti-HBc response and induces HBc-specific CTL response in immunized Balb/c mice.

Intrahepatic distribution of hepatitis B virus antigens in patients with and without hepatocellular carcinoma

AIM: To study the intrahepatic expression of hepatitis B surface antigen(HBs Ag) and hepatitis B core antigen(HBc Ag) in chronic hepatitis B patients with and without hepatocellular carcinoma. METHODS: A total of 33 chronic hepatitis B patients(mean age of 40.3 ± 2.5 years), comprising of 14 HBe Ag positive and 19 HBe Ag negative patients; and 13 patients with hepatitis B virus related hepatocellular carcinoma(mean age of 49.6 ± 4.7 years), were included in our study. Immunohistochemical staining for HBc Ag and HBs Ag was done using standard streptavidin-biotin-immunoperoxidase technique on paraffin-embedded liver biopsies. The HBc Agand HBs Ag staining distributions and patterns were described according to a modified classification system. RESULTS: Compared to the HBe Ag negative patients, the HBe Ag positive patients were younger, had higher mean HBV DNA and alanine transaminases levels. All the HBe Ag positive patients had intrahepatic HBc Ag staining; predominantly with "diffuse" distribution(79%) and "mixed cytoplasmic/nuclear " pattern(79%). In comparison, only 5% of the HBe Ag-negative patients had intrahepatic HBc Ag staining. However, the intrahepatic HBs Ag staining has wider distribution among the HBe Ag negative patients, namely; majority of the HBe Ag negative cases had "patchy" HBs Ag distribution compared to "rare" distribution among the HBe Ag positive cases. All but one patient with HCC were HBe Ag negative with either undetectable HBV DNA or very low level of viremia. Intrahepatic HBc Ag and HBs Ag were seen in 13(100%) and 10(77%) of the HCC patients respectively. Interestingly, among the 9 HCC patients on anti-viral therapy with suppressed HBV DNA, HBc Ag and HBs Ag were detected in tumor tissues but not the adjacent liver in 4(44%) and 1(11%) patient respectively. CONCLUSION: Isolated intrahepatic HBc Ag and HBs Ag can be present in tumors of patients with suppressed HBV DNA on antiviral therapy; that may predispose them to cancer development.

Humoral and cellular immunogenecity of DNA vaccine based on hepatitis B core gene in rhesus monkeys

INTRODUCTIONHepatitis B virus (HBV) is the most commonetiologic agent for infectious liver diseases. It isestimated that there are more than 250 millionchronic HBV carriersin the world today and thereis a significant association among persistentinfection, liver cirrhosis and hepatocellularcarcinoma[1-3].

Hepatitis C virus antigens enzyme immunoassay for one-step diagnosis of hepatitis C virus coinfection in human immunodeficiency virus infected individuals

BACKGROUND Current diagnosis of hepatitis C virus(HCV)infection requires two sequential steps:testing for anti-HCV followed by HCV RNA PCR to confirm viremia.We have developed a highly sensitive and specific HCV-antigens enzyme immunoassay(HCV-Ags EIA)for one-step diagnosis of viremic HCV infection.AIM To assess the clinical application of the HCV-Ags EIA in one-step diagnosis of viremic HCV infection in human immunodeficiency virus(HIV)-coinfected individuals.METHODS The study blindly tested HCV-Ags EIA for its performance in one-step diagnosing viremic HCV infection in 147 sera:10 without HCV or HIV infection;54 with viremic HCV monoinfection;38 with viremic HCV/HIV coinfection;and 45 with viremic HCV and non-viremic HIV coinfection.RESULTS Upon decoding,it was 100%accordance of HCV-Ags EIA to HCV infection status by HCV RNA PCR test.In five sera with HCV infection,HCV RNA was as low as 50-59 IU/mL,and four out of five tested positive for HCV-Ags EIA.Likewise,it was also 100%accordance of HCV-Ags EIA to HCV infection status by HCV RNA PCR in 83 sera with HCV and HIV coinfection,regardless if HIV infection was active or not.CONCLUSION The modified HCV-Ags EIA has a lower detection limit equivalent to serum HCV RNA levels of approximately 100 IU/mL.It is highly sensitive and specific in the setting of HIV coinfection,regardless of HIV infection status and CD4 count.These data support the clinical application of the HCV-Ags EIA in one-step diagnosis of HCV infection in HIV-infected individuals.

Cloning and characterization of a novel hepatitis B virus core binding protein C12

AIM: To elucidate the biological function of HBV core antigen (HBcAg) on pathogenesis of hepatitis B, a novel gene C12 coding for protein with unknown function interacting with HBcAg in hepatocytes was identified and characterized. METHODS: HBcAg bait plasmid pGBKT7-HBcAg was constructed and transformed into yeast AH109, then the transformed yeast was mated with yeast Y187 containing liver complementary DNA (cDNA) library plasmid in 2×YPDA medium. Diploid yeast was plated on synthetic dropout nutrient medium (SD/-Trp-Leu-His-Ade) and synthetic dropout nutrient medium (SD/-Trp-Leu-His-Ade)containing X-α-gal for screening twice. After extracting and sequencing of plasmid from blue colonies, we isolated a cDNA clone encoding a novel protein designated as C12that directly interacted with HBcAg. The interaction between HBcAg and C12 was verified again by re-mating.pEGFP-N1-C12 fluorescent protein fusion gene was transfected in 293 and L02 cell, and observed by fluorescent microscope. MTT reduction assay was used to study the action of C12 protein effect on metabolism of mammal cell. Yeast two-hybrid and cDNA microarray were performed to search binding protein and differential expression genes regulated by C12 protein.RESULTS: C12 gene was screened and identified by yeast two-hybrid system 3. The interaction between HBcAg and the novel protein coded by the new gene C12 was further confirmed by re-mating. After 48 h, fluorescence of fusion protein could be observed steadily in the 293 and L02 cell plasma. Under MTT assay, we found that the expression of C12 did not influence the growth of liver cells. Seventeen differential expression genes in HepG2 cells transfected with C12 protein expression plasmid by cDNA microarray,of which 16 genes were upregulated and 1 gene was downregulated by C12 protein. Twenty-one colonies containing 16 different genes coding for C12 protein binding proteins were isolated by yeast two-hybrid, there were 2 new genes with unknown function.CONCLUSION: The novel protein C12 is located in cell plasma, and its overexpression has no significant effect on the metabolism of liver cell. It interacts with many proteins in hepatocytes and may be involved in many processes of gene expression.

广州市花地街道55岁及以上健康体检居民乙型病毒性肝炎流行状况分析

目的:了解广州市花地街道55岁及以上中老年健康体检人群乙型病毒性肝炎(简称乙肝)感染及疫苗接种情况。方法:对940名55岁及以上中老年体检居民采集静脉血,采用酶联免疫吸附试验进行血清学检测,描述其阳性率及分布特征。结果:共调查940人,乙肝病毒表面抗原(HBsAg)阳性率、乙肝病毒表面抗体(HBsAb)阳性率和乙肝病毒核心抗体(HBcAb)阳性率分别为8.30%,60.74%,30.11%。不同年龄、乙肝既往史比较,HBsAg阳性率差异有统计学意义(P<0.05);不同乙肝既往史、乙肝疫苗接种史比较,HBsAb阳性率差异有统计学意义(P<0.05)。有乙肝既往史的户籍、已婚人群为高危人群,无乙肝疫苗接种史的女性、高中/中专、户籍、已婚人群为高危人群;不同乙肝既往史比较,HBcAb阳性率差异有统计学意义(P<0.05)。乙肝病毒易感率为27.26%。不同户籍类型比较,乙肝病毒易感率差异有统计学意义(P<0.05)。结论:花地街道55岁及以上人群乙肝表面抗原阳性率水平较高,应对易感人群补种、加强或重新接种乙肝疫苗,提高人群免疫水平,降低乙肝病毒易感率。

核心抗体阳性献血者的跟踪研究

目的通过跟踪核心抗体(抗-HBc)阳性献血者再次献血时的HBV检测结果,评价抗-HBc在现有的HBV血液筛查策略下对于血液安全的意义。方法随机留取大连市血液中心采集血液的血浆标本。采用ELISA法检测抗-HBc(2种试剂)和抗-HBs。对抗-HBc+血液筛查合格献血者的再次献血和HBV筛查反应性献血者随访的情况进行跟踪。结果2017年5月~2018年3月随机留取了1291份血浆标本。其中抗-HBc+标本405份(31.4%)。抗-HBc+献血者年龄中位数(39岁)高于抗-HBc-献血者(31岁)(P<0.05),性别、首次/重复献血者比例无差异(P>0.05)。在405位抗-HBc+献血者中确证OBI 3人(0.7%),其中1人在再次献血时被确证。3位OBI献血者在随访中均不能检出HBV DNA。结论鉴于抗-HBc+献血者的比例较高,目前仍不具备将抗-HBc检测纳入血液筛查的条件,但抗-HBc检测对于HBV筛查反应性的献血者归队评估有着重要的应用价值。

乙肝核心相关抗原联合AFP、PIVKA-Ⅱ对乙肝相关肝癌的诊断价值研究

目的探讨乙肝感染不同阶段的乙肝核心相关抗原(hepatitis B core-related antigen,HBcrAg)水平及HBcrAg联合AFP、异常凝血酶原(protein induced by vitamin K absence-Ⅱ,PIVKA-Ⅱ)对乙肝相关肝癌的诊断价值。方法选取2019年10月至2021年3月首都医科大学附属北京佑安医院的HBsAg阳性患者562例,根据临床诊断分为慢乙肝组(173例)、肝硬化组(218例)、肝癌组(54例)和肝癌术后组(117例);分别以HBsAg 3.0 Log IU/ml,HBcrAg 4.0 Log U/ml为界将所有患者分为4组,其中低HBsAg低HBcrAg组(142例)、低HBsAg高HBcrAg组(124例)、高HBsAg低HBcrAg组(31例)和高HBsAg高HBcrAg组(113例)。比较各组HBcrAg、AFP、PIVKA-Ⅱ等血清学标志物水平,采用ROC曲线评估HBcrAg、AFP和PIVKA-Ⅱ对乙肝相关肝癌的诊断价值。结果562例患者中,男403例,女159例;年龄7~81岁,中位年龄51.0岁。临床诊断各组HBcrAg、AFP、PIVKA-Ⅱ等指标的比较,差异均有统计学意义(P<0.05);低HBsAg高HBcrAg组肝癌患病比例为12.1%(15/124),高于其他组(P<0.05)。HBcrAg、AFP和PIVKA-Ⅱ诊断HCC的ROC曲线的AUC分别为0.544(95%CI:0.473~0.613,P<0.05)、0.774(95%CI:0.712~0.829,P<0.05)和0.847(95%CI:0.790~0.893,P<0.05),灵敏度分别为53.1%、66.7%和76.7%,特异性分别为61.7%、86.0%和87.3%;三者联合诊断HCC的ROC曲线的AUC为0.795(95%CI:0.697~0.893,P<0.05),灵敏度为83.0%,特异性为67.0%。结论肝癌组HBcrAg高于慢乙肝组、肝硬化组和肝癌术后组。在核苷类似物治疗情况下,HBcrAg单一指标不能很好地对肝癌进行预测,HBcrAg联合AFP、PIVKA-Ⅱ可提高肝癌诊断的灵敏度。