肝硬化患者乙肝表面抗原的定量检测及意义

目的：探讨HBsAg定量测定在乙肝相关性肝硬化病程中的变化和意义。方法：选择乙肝相关性肝硬化患者60例纳入实验对象,根据2000年9月（西安）第10次全国病毒性肝炎学术会议修订的《病毒性肝炎防治方案》中的诊断标准分为代偿期组和失代偿期组,其中代偿期组35例,失代偿期组25例。另选取20例乙型肝炎病毒携带者作为对照组。应用电化学发光免疫分析法测定患者血清中HBsAg和HBeAg滴度,免疫荧光定量PCR法检测HBVDNA载量。结果：对照组、肝硬化代偿期组和肝硬化失代偿期组HBsAg滴度分别为：2574.73±3252.27COI、5494.35±2129.84COI和6921.25±1957.60COI,三组之间差别均有统计学意义（P〈0.05）。肝硬化代偿期组中,HBsAg滴度与HBVDNA、HBeAg水平呈负相关性（P〈0.05（）r=-0.350;r=-0.514）。肝硬化失代偿期组中,HBsAg滴度与HBVDNA及HBeAg水平均无明显相关性（r=-0.020;r=0.154）。结论：肝硬化失代偿期HBsAg滴度明显高于肝硬化代偿期,代偿期HBsAg滴度高于HBV携带者组,即HBsAg滴度随肝脏疾病进展呈阶梯型递增。肝硬化代偿期,HBsAg滴度与HBVDNA、HBeAg水平呈负相关性,HBsAg水平可以作为评估病毒复制的参考指标。肝硬化失代偿期,HBsAg滴度与HBVDNA和HBeAg无相关性,不能反映病毒复制水平,不能作为评估病毒复制的参考指标。

Quantitation Detection of Hepatitis B Surface Antigen and Its Significance in Patients with Hepatic Cirrhosis

Objective： To assess the clinical significance of the quantitation of HBsAg in HBV-associated hepatic cirrhosis. Method： Sixty HBV-associated hepatic cirrhosis patients were included in the study. The patients were divided into the compensated cir- rhosis group （n = 35） and the decompensated cirrhosis group （n = 25） based on the diagnostic criteria of hepatitis determined at the 10th National Conference on Viral Hepatitis （Xi＇an, September 2000）. 20 asymptomatic healthy hepatitis B carriers were recruited as the con- trol group. The serum titers of HBsAg and HBeAg were determined using electrochemiluminescence immunoassay （ECLIA）, and HBV DNA load was measured using immunofluorescence quantitative polymerase chain reaction assay（PCR）. Result： HBsAg level in the con- trol group, compensated cirrhosise group and decompensated cirrhosis group were 2574.73 ± 3252.27 COI, 5494.35 ± 2129.84 COI and 6921.25 ± 1957.60 COI, respectively. The differences among the three groups were statistically significant （P0.05）. In compensat- ed cirrhosis group, the pearson correlation in HBsAg vs. HBV DNA and HBsAg vs. HBeAg were significantly reverse correlation （P0. 05）, with r values of -0.350 and -0.514 respectively. In decompensated cirrhosis group, HBsAg had no significant correlation with HBV DNA or HBeAg, with r values of -0.020 and 0.154 respectively. Conclusion： HBsAg level is significantly higher in decompensated cir- rhosis group than in compensated cirrhosis group, it is also higher in compensated cirrhosise group than in control group. With the pro- gression of liver disease, a rising HBsAg gradient is observed. In compensated cirrhosis group, HBsAg level has a significantly reverse correlation with HBV DNA and HBeAg, hence HBsAg is a indirect index to reflect viral replication. In decompensated cirrhosis, HBsAg has no significant correlation with HBV DNA and HBeAg, suggesting that HBsAg does not reflect the activity of viral replication.