血清乙肝病毒大蛋白与乙肝前S1抗原联合检测在HBeAg阴性乙肝患者诊断中的意义

目的 探讨乙型肝炎e抗原阴性[HBeAg（－）]乙肝患者血清乙肝病毒大蛋白（HBV-LP）和乙肝前S1抗原（PreS1-Ag）联合检测的临床意义。方法 采用酶联免疫吸附（ELISA）法测定300例慢性乙肝患者的血清HBV-LP和PreS1-Ag浓度；实时荧光定量PCR（qRT-PCR）法检测血清HBV-DNA表达量；比较不同HBV-M模式下HBV-LP、PreS1-Ag与HBV-DNA的阳性检出率；分析以HBV-DNA表达量作为HBV感染及复制的金标准时，血清HBV-LP和PreS1-Ag单独检测及联合检测对HBeAg阴性乙肝患者的阳性预测值和阴性预测值。结果 （1）115例HBeAg（+）血清中，HBV-LP和PreS1-Ag的阳性率均与HBV-DNA阳性率差异无统计学意义（Ps＞0.05）；120例HBeAg（－）HBeAb（+）血清中，HBV-LP阳性率（64.2%）明显高于HBV-DNA阳性率（P＜0.05），而PreS1-Ag阳性率与HBV-DNA阳性率差异无统计学意义（P＞0.05）；65例HBeAg（－）HBeAb（－）血清中，HBV-LP阳性率（72.3%）和PreS1-Ag阳性率（67.7%）均明显高于HBV-DNA阳性率（Ps＜0.05）；（2）以185例HBeAg（－）乙肝患者的HBV-DNA表达量为参考标准，HBV-LP、PreS1-Ag的阳性预测值分别为72.6%、71.6%，阴性预测值分别为93.4%、84.1%；HBV-LP和PreS1-Ag联合检测，HBV-LP/PreS1-Ag双阳性中的HBV-DNA阳性率（66.0%）显著高于HBV-LP/PreS1-Ag双阴性（P＜0.05）。结论 血清HBV-LP和PreS1-Ag水平与HBV-DNA表达量有关，二者联合检测可灵敏地反映HBeAg（－）乙肝患者HBV的复制状态，预测HBV-DNA水平。

Significance of combined detection of hepatitis B virus large surface protein and PreS1 antigen in the diagnosis of HBeAg-negative hepatitis B

Objective To explore the significance of combined detection of hepatitis B virus large surface protein（HBV-LP）and PreS1 antigen（PreS1-Ag）in the diagnosis of HBeAg- hepatitis B（HB）．Methods HBV-LP and PreS1-Ag were detected with enzyme linked immunosorbent assay（ELISA），and the expression of HBV-DNA was detected by using quantitative real-time PCR（qRT-PCR）．The positive rates of HBV-LP，PreS1-Ag and HBV-DNA were compared among the HB patients with different HBV-marker（HBV-M）models．The positive and negative predictive values of HBV-LP and PreS1-Ag in independent/joint detection for HBeAg-HB patients were analyzed based on the expression of HBV-DNA，which was used as the gold standard for HBV infection and replication．Results （1）In the 115 HBeAg+ cases，the positive rates of HBV-LP and PreS1-Ag were not significantly different from that of HBV-DNA（Ps>0.05）．In the 120 HBeAg-/HBeAb+ HB patients，the positive rate of HBV-LP（64.2%）was obviously higher than that of HBV-DNA（P0.05）．In the 65 HBeAg-/HBeAb- HB patients，the positive rates of HBV-LP（72.3%）and PreS1-Ag（67.7%）were both significantly higher than that of HBV-DNA（Ps<0.05）．（2）Based on the HBV-DNA expression of 185 HBeAg-HB patients，the positive/negative predictive values of HBV-LP and PreS1-Ag were 72.6%/71.6% and 93.4%/84.1%，respectively．The positive rate of HBV-DNA in patients with positive HBV-LP/PreS1-Ag（66.0%）was significantly higher than that in patients with negative HBV-LP/PreS1-Ag（P<0.05）．Conclusion Serum levels of HBV-LP and PreS1-Ag were related to the expression level of HBV-DNA，combined detection of HBV-LP and PreS1-Ag could sensitively reflect the replication of HBV in HBeAg- HB patients，and predict the level of HBV-DNA．