HBeAg阳性慢性乙型肝炎患者血清HBeAg与肝组织病理的相关性研究

目的探讨慢性乙型肝炎（cHB）患者血清HBeAg与肝组织炎症活动度及纤维化程度的关系。方法采用回顾性病例序列研究方法，搜集我院2005年1月至2009年12月行肝组织活检术的137例HBeAg阳性CHB患者的临床资料，血清HBeAg滴度均采用微粒子免疫发光法检测，血清HBVDNA采用荧光定量PCR法检测。结果肝组织炎症分级及纤维化分期与血清HBeAg滴度呈负相关，与ALT水平呈正相关，与HBVDNA水平无相关性；血清HBeAg和ALT水平可独立预测肝组织炎症≥G2和纤维化≥S2，优于血清HBVDNA水平和年龄；且血清HBeAg预测肝组织炎症≥G2的价值优于ALT，而预测纤维化≥S2的价值略低于ALT。肝细胞HBcAg阳性组血清HBeAg、HBVDNA水平均高于肝细胞HBcAg阴性组（均P〈0．01）。血清HBeAg滴度预测肝细胞表达HBcAg的灵敏度、特异度分别为80．02％和65．89％，高于血清HBVDNA（78．89％和43．21％）。血清HBeAg滴度与HBVDNA水平呈正相关（r=0．274，P=0．002），与ALT水平呈负相关（r=0．212，P=0．013）。结论血清HBeAg与肝组织炎症程度及纤维化分期呈负相关；血清HBeAg滴度预测肝组织炎症程度的价值优于年龄、血清ALT、HBVDNA水平，预测肝纤维化程度的价值低于ALT。血清HBeAg较血清HBVDNA更能反映肝细胞内HBV复制情况。

Relationship between serum HBeAg titer and intrahepatic inflammation or fibrosis in patients with HBeAg positive chronic hepatitis B

ABSTRACT：The purpose of the present study is to explore the correlation between serum HBeAg titer and intrahepatic in- flammatory or fibrosis in patients with HBeAg positive chronic hepatitis B. We retrospectively collected the clinical data of 137 patients who were received histopathological detection through puncture biopsy from January 2005 to December 2009 in our hospital. The serum HBeAg was quantified by microparticle enzyme immunoassay, and serum HBV DNA was detected by fluo- rescence quantitative PCR. It was found that the grade of inflammation and fibrosis of liver tissue was negatively correlated with serum HBeAg titer, and was positively correlated with serum ALT level, but no correlation with serum HBV DNA. Ser- um HBeAg and ALT levels might be an independent predictor of liver inflammation ≥ G2 and fibrosis ≥S2, and superior to serum HBV DNA and age. Serum HBeAg titer predicted the liver inflammation ≥G2 was better than ALT, while the power of forecasting fibrosis ≥S2 was slightly weaker than ALT. The serum HBeAg titer and HBV DNA levels in HBcAg expressing positive group were higher than those in HBcAg expressing negative group （all P〈0.01）. The sensitivity and specificity of HBeAg titer predicted the intrahepatic expression of HBcAg were 80.02% and 65.89%, respectively, which was superior to HBV DNA （78.89% and 43.21%, respectively）, with the area under the curve was 0. 754 （P〈0. 001）. Meanwhile, serumHBeAg titer was positively correlated with HBV DNA, and was negatively correlated with ALT. These results reveal that serum HBeAg titer is negatively correlated with the grade of inflammation and fibrosis of liver tissue. Serum HBeAg titer is better than age, HBV DNA and ALT in pre-dicting liver inflammation, while slightly less than ALT in forecasting fibrosis ~$2. The serum HBeAg is better than serum HBV DNA to reflect HBV replication in the liver cells.