Pre S1抗原与HBV血清学标志物和HBV DNA的相关性及临床意义

目的:分析探讨乙型肝炎病毒(HBV)pre S1与HBV血清学标志物(乙肝两对半)和HBV DNA之间的相关性及联合检测的临床意义与应用价值。方法:用酶联免疫吸附法检测pre S1和乙肝两对半,用荧光定量PCR检测HBV DNA,观察不同模式中pre S1的表达水平和HBV DNA的含量,对结果进行统计分析。结果:共收集门诊及住院受检者血清标本2 180例,在1 971例HBsAg阳性的血清标本中pre S1和HBV DNA的检出率均较高,且二者具有明显的相关性,大三阳、小三阳和HBsAg/抗-HBc(+)三种模式中pre S1的阳性率分别为94.3%、59.1%和78.9%;pre S1在HBeAg阳性组和HBV DNA阳性组中的阳性率为94.3%和84.9%,明显高于在HBeAg阴性组和HBV DNA阴性组中的62.1%和56.3%(P<0.01);且大三阳组的HBV DNA含量也远高于其他组(多数高于105copies/ml),尤其是pre S1也是阳性的同时,HBV DNA拷贝数多高于107 copies/ml,呈高拷贝复制;而正常人群(血清学标志物全阴性)pre S1检出阴性。结论:pre S1能较好的反映乙肝病毒的存在与复制情况,联合检测pre S1和乙肝两对半,结合HBV DNA定量检测,可早期发现低水平的病毒感染,是判读抗病毒治疗疗效的较好参考指标,尤其在检验条件相对较差的基层医院,对乙肝患者的临床诊断、病情判读和疗效观察都有良好的应用价值。

Clinical Value of Serum pre S1 Antigen Detection and Its Relation to HBV Serological Markers and DNA

Objective:To analyze the correlation between pre S1antigen,HBV related serological markers and HBV DNA in the HBV diagnosis.Methods:ELISA was applied to detect the HBV pre S1 antigen and related serological markers,and the HBV DNA was detected by fluorescence quantitative PCR.The correlation of these indices were statistically analyzed.Results:In the 2 180cases involved,the positive rates of pre S1antigen in patients with HBsAg/HBeAg/HBcAb(+), HBsAg/HBeAb/HBcAb(+),HBsAg/HBcAb(+)were 94.3%,59.1% and 78.9%,respectively.And the positive rates of pre S1antigen were 94.3%and 84.9%in HBeAg(+)group and HBV DNA(+)group,which were significantly higher than 62.1% and 56.3%in the HBeAg(-)group and HBV DNA(-)group(P<0.01).The expression level of HBV DNA in HBsAg/HBeAg/HBcAb(+)group was much higher than the others(mostly>105copies/ml),especially in pre S1antigen positive simultaneously,the HBV DNA duplicating was in a high rate even more than 107copies/ml.While in the healthy group,the pre S1is negative.Conclusion:The pre S1antigen could reflect the existence and replication of HBV effectively.The combined test of pre S1antigen,related serological markers and HBV DNA,could detect the low level infection of HBV in early stage.It is a useful indicator for clinical diagnosis,monitoring,and therapeutic evaluation in patients infected with HBV,especially in the primary hospitals where the test conditions are relatively poor.