慢性HBV感染不同状态下HBsAg定量的临床意义

目的 探讨HBsAg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)、HBeAg阳性慢性乙型肝炎(chronic hepatitis B,CHB)组(n=25)、非活动携带组(n=24)及HBeAg阴性CHB组(n=34),肝硬化患者分为HBeAg阳性组(n=33)及HBeAg阴性组(n=35)。检测患者血清HBsAg、HBV DNA、ALT等指标。 结果 无肝硬化的慢性HBV感染患者HBsAg水平由高到低为:免疫耐受组(4.60±0.32)log₁₀IU/ml)]、HBeAg阳性CHB组(4.36±0.45)log₁₀IU/ml]、非活动携带组(3.51±0.30)log₁₀IU/ml]、HBeAg阴性CHB组(3.62±0.35)log₁₀IU/ml]。无肝硬化患者,年龄与HBsAg水平呈负相关(P=0.000);ALT与HBsAg水平无相关性(P=0.152)。免疫耐受及HBeAg阳性CHB组HBsAg水平与HBV DNA呈正相关(P=0.000,P=0.009)。HBeAg阳性肝硬化患者HBsAg水平(4.27±1.33) log₁₀IU/ml]与HBeAg阴性患者(3.81±1.07) log₁₀IU/ml]相似,HBsAg与年龄及ALT无相关性(P>0.05)。 结论 HBsAg水平在HBeAg阳性患者中可反映HBV DNA复制情况。无论有无肝硬化存在,HBsAg水平都不能反映肝组织炎性情况。

Clinical Implications of HBsAg Quantitation Under Different Conditions of Chronic HBV Infection

Objective To investigate the clinical implications of HBsAg 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), HBeAg-positive chronic hepatitis B (chronic hepatitis B, CHB) group (n=25), inactive carrier group (n = 24) and HBeAg-negative CHB group (n=34); patients with cirrhosis were divided to HBeAg-positive (n=33) and HBeAg-negative groups (n=35). We detected serum HBsAg, HBV DNA, ALT and other indicators. Results For patients without cirrhosis, HBsAg levels were (4.60±0.32) log₁₀IU/ml in immune tolerance group, (4.36±0.45) log₁₀IU/ml in HBeAg-positive CHB group, (3.51±0.30) log₁₀IU/ml in the inactive carries group, and (3.62±0.35) log₁₀IU/ml in HBeAg-negative CHB group. For patients without cirrhosis, their age was correlated with HBsAg level (P=0.000), but no correlation existed between ALT and HBsAg (P=0.152). HBsAg levels of immune tolerance and HBeAg-positive CHB groups were correlated with HBV DNA levels (P=0.000,P=0.009). HBsAg levels of HBeAg-positive (4.27±1.33) log₁₀IU/ml and HBeAg-negative (3.81±1.07) log₁₀IU/ml groups were similar in cirrhotic patients, and HBsAg was not correlated with age or ALT (P>0.05). Conclusion HBsAg level in HBeAg-positive patients may reflect HBV DNA replication. In patients with or without cirrhosis, HBsAg can not reflect the inflammation of the liver.