慢性乙型肝炎患者血清HBV DNA、HBeAg与肝组织HBcAg及炎症分级的关系

目的 探讨慢性乙型肝炎（CHB）患者血清HBV DNA、HBeAg与肝组织HBcAg及炎症分级的关系.方法 回顾性分析250例CHB肝穿刺患者,按血清HBV DNA水平,分为A组（＜3 log10 IU/ml）45例,B组（3～6 log10 IU/ml）138例,C组（＞6 log10 IU/ml）67例.按HBeAg阴阳性不同分为阳性组142例,阴性组108例.分别与肝组织中HBcAg水平、肝组织炎症分级进行比较,分析彼此的相关性,率的比较用卡方检验及确切概率法,相关性分析采用直线相关分析.结果 血清HBV DNA不同水平与肝组织HBcAg免疫组化比较差异有统计学意义（χ2=11.1,P=0.05）,两者之间呈正相关（r=0.75,P=0.001）;与肝组织炎症分级（G）比较差异无统计学意义（χ2=13.3,P=0.075）,两者之间也无相关性（r=0.04,P=0.325）.HBeAg阳性和阴性分组与肝组织中HBcAg水平比较差异有统计学意义（χ2=6.64,P=0.01）,两者之间呈正相关（r=0.56,P=0.001）;与肝组织炎症分级（G）比较差异无统计学意义（χ2=8.43,P=0 065）,两者之间也无相关性（r=0.06,P=0.415）.结论 CHB患者肝组织HBcAg表达更能反映出肝内HBV复制状态,患者血清中测不出病毒标志物时,可以考虑肝穿刺以观察肝组织中HBcAg表达来判断HBV复制状态具有重要意义.

Relationship between HBV DNA and HBeAg in serum and HBcAg and inflammation grade in liver tissue among patients with chronic hepatitis B

Objective To investigate the relationship between HBV DNA and HBeAg in serum and HBcAg and inflammation grade in liver tissue among chronic hepatitis B （CHB） patients. Methods A retrospective analysis was performed on 250 CHB patients who underwent liver biopsy. These patients were divided into three groups according to serum levels of HBV DNA： group A （ 〈 3 log10 IU/ml, n = 45 ） , group B （ 3 - 6 lOgl0 IU/ml, n = 138 ） , and group C （ 〉 6 lOgl0 IU/ml, n = 67 ） , and they were also divided into HBeAg - positive group （ n = 142） and HBeAg - negative group （ n = 108 ）. The positive rate of HBcAg and inflammation grade in liver tissue were compared between groups, and correlations were analyzed. Comparisons of rates were made by chi - square test and Fisher＇s exact test; correlations were deter- mined by linear correlation analysis. Results There were significant differences in positive rate of HBcAg between groups A, B, and C （X2 = 11.1, P = 0.05） , and serum HBV DNA level was positively correlated with the positive rate of HBcAg in liver tissue （ r = 0. 75, P = 0. 001 ）. There were no significant differences in inflammation grade between groups A, B, and C （X2 = 13.3, P =0. 075 ） , and no correla- tion was found between serum HBV DNA level and inflammation grade in liver tissue （ r = 0. 04, P = 0. 325 ）. There was significant differ- ence in positive rate of HBeAg between the HBeAg - positive group and HBeAg - negative group （X2 = 6. 64, P = 0.01 ） , and the presence or absence of HBeAg in serum was positively correlated with the positive rate of HBeAg in liver tissue （ r = 0. 56, P = O. 001 ）. There was no significant difference in inflammation grade between the HBeAg - positive group and HBeAg - negative group （X2 = 8.43, P = 0. 065 ）, and no correlation was found between the presence or absence of HBeAg in serum and inflammation grade in liver tissue （ r = 0. 06, P = 0.415 ）. Conclusion The expression of HBcAg in liver tissue can better reflect HBV replication in the liver among CHB patients. When HBV mark- ers cannot be detected in the serum of oatients, liver bionsv can be used to detect HBcA~ in liver tissue and assess HBV replication.