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目的探讨慢性乙型肝炎(chronic hepatitis B,CHB)患者病毒复制及其抗原表达水平预测肝组织病理状态的价值。方法进行肝活检的CHB患者695例,血清HBs Ag和HBe Ag采用Abbott Architect I2000检测,血清HBV DNA采用实时定量PCR检测,肝组织HBs Ag和HBc Ag采用免疫组织化学法检测。结果 HBe Ag阳性患者,血清HBs Ag、HBe Ag水平和HBV DNA载量与病理学分级和分期均呈显著负相关(P<0.01);肝组织HBs Ag表达水平与病理学分级和分期均无显著相关性(P>0.05),HBc Ag表达水平与病理学分级和分期均呈显著负相关(P<0.01)。HBe Ag阴性患者,血清HBs Ag水平与病理学分级和分期均无显著相关性(P>0.05),HBV DNA载量与病理学分级和分期均呈显著正相关(P<0.01);肝组织HBs Ag表达水平与病理学分级和分期均无显著相关性(P>0.05),HBc Ag表达水平与病理学分级和分期分别呈显著正相关(P<0.05)和无显著相关性(P>0.05)。有序Logistic回归分析显示,HBe Ag阳性患者血清HBs Ag、HBe Ag水平和HBV DNA载量、肝组织HBc Ag表达水平预测病理学分级和分期的回归系数均有统计学意义(P<0.05);HBe Ag阴性患者,只有血清HBV DNA载量预测病理学分级的回归系数有统计学意义(P<0.01)。结论 HBe Ag阳性患者,血清HBs Ag、HBe Ag水平和HBV DNA载量、肝组织HBc Ag表达水平均有预测肝组织病理学分级和分期的意义;HBe Ag阴性患者,只有血清HBV DNA载量有预测肝组织病理学分级的意义。
Objective To investigate the value of viral replication and antigen expression in chronic hepatitis B (CHB) patients to predict the pathological state of liver. Methods 695 CHB patients with liver biopsy, HBsAg and HBeAg were detected by Abbott Architect I2000, serum HBV DNA was detected by real-time PCR, and HBsAg and HBcAg were detected by immunohistochemistry. Results HBeAg-positive patients, serum HBsAg, HBeAg levels and HBV DNA load were significantly and negatively correlated with the pathological grade and stage (P <0.01). There was no significant difference in the expression of HBsAg between the HBsAg positive group and pathological grade and stage (P> 0.05). There was a significant negative correlation between HBc Ag expression and pathological grade and stage (P <0.01). There was no significant correlation between serum HBsAg and pathological grading and staging in patients with HBe Ag-negative (P> 0.05). There was a significant positive correlation between HBV DNA load and pathological grading and staging (P <0.01) There was no significant correlation between the expression level of Ag and pathological grade and stage (P> 0.05). There was a significant positive correlation between the expression level of HBcAg and pathological grade and stage (P <0.05) . Logistic regression analysis showed that the serum HBsAg and HBeAg levels, HBV DNA load and HBcAg expression level in HBeAg positive patients were significantly different (P <0.05). In HBeAg-negative patients, only the regression coefficient of serum HBV DNA load-predicted pathological grade was statistically significant (P <0.01). Conclusion HBeAg-positive patients, serum HBsAg, HBeAg levels and HBV DNA load, liver tissue HBcAg expression level of liver histopathological grading and staging significance; HBeAg-negative patients, only serum HBV DNA load Predict the significance of histopathological grade of liver tissue.