HBsAg及HBV DNA定量水平在慢性乙型肝炎、肝硬化和肝癌患者中的变化

目的 了解HBsAg定量水平在慢性乙型肝炎、乙型肝炎肝硬化、HBsAg阳性的原发性肝癌患者中的变化及其在3组患者中与HBV DNA的相关性. 方法 采集47例慢性乙型肝炎患者(乙型肝炎组),72例乙型肝炎肝硬化患者(肝硬化组)及54例肝癌患者(肝癌组)的血清标本,用雅培化学发光法进行HBsAg定量测定,荧光PCR定量法检测HBV DNA量水平.多组分析采用Kruskal-Wallis检验,两组间比较采用Mann-WhitneyU检验,相关性分析采用Spearman检验.结果 HBsAg定量值在乙型肝炎、肝硬化、肝癌组患者中的中位数分别为2361.10、1001.64、594.35IU/ml,3组间呈逐渐下降趋势,x2= 24.394,P＜0.05,差异有统计学意义;乙型肝炎组与肝硬化组比较,Z= -3.754,P＜0.05,差异有统计学意义;乙型肝炎组与肝癌组比较,Z=-4.630,P＜0.05,差异有统计学意义;而肝硬化组与肝癌组比较,差异无统计学意义.HBeAg阳性患者,HBsAg定量值在乙型肝炎组、肝硬化组、肝癌组患者的中位数分别为3259.83、1077.30、789.72 IU/ml,3组间呈下降趋势,x2= 15.643,P＜0.01,差异有统计学意义.对于HBeAg阴性患者,HBsAg定量值在乙型肝炎组、肝硬化组、肝癌组患者的中位数分别为1669.00、1001.64、582.05 IU/ml,3组间呈下降趋势,x2 =6.423,P＜0.05,差异有统计学意义.HBV DNA定量值在乙型肝炎组、肝硬化组、肝癌组患者的中位数分别为5.3579、 4.2207、1.0000 log10拷贝/ml,4分位数间距分别为(4.3579 ～6.8745)、(0.0000 ～ 5.7393)、(0.0000 ～ 4.6651)log10拷贝/ml,3组HBV DNA定量值比较,x2=31.412,P＜0.05,差异有统计学意义; HBsAg与HBV DNA在乙型肝炎组(r= 0.297,P＜0.05)、肝硬化组(r= 0.346,P＜0.05)、肝癌组(r=0.452,P＜0.05)均呈正相关.结论 HBsAg定量值在慢性乙型肝炎、肝硬化、肝癌患者中逐渐降低,且与HBV DNA水平正相关.

The discrepancy of HBsAg titre and HBV DNA in patients with chronic hepatitis B, HBV-related liver cirrhosis and hepatocellular carcinoma

Objective To investigate the discrepancy of HBsAg titre and correlation ofHBV DNA levels among patients with chronic hepatitis B (CHB),HBV-related liver cirrhosis (LC) and hepatocellular carcinoma (HCC).Methods HBsAg titre and HBV DNA in serum samples were measured among 47 CHB,72 LC and 54HCC cases using Abbott chemiluminescence and fluorescence quantitative PCR,respectively.Statistical analyses among multiple groups,between two groups and about the correlation were performed using Kruskal-Wallis test,Mann-Whitney U test and Spearman test,respectively.Results The median HBsAg titre level in serum samples decreased from 2361.10 IU/ml in CHB cohort to 1001.64 IU/ml in LC cohort and 594.35 IU/ml in HCC cohort,suggesting a statistically significant difference (x2 = 24.394,P ＜ 0.05).Moreover,HBsAg titre in CHB group was significantly higher than that in LC group (Z = -3.754,P ＜ 0.05).CHB patients had significantly higher HBsAg titre than HCC cases (Z = -4.630,P ＜ 0.05).However,there was no statistically significant difference in HBsAg titre between LC and HCC group.Among HBeAg positive patients,HBsAg titre decreased from 3259.83 IU/mlin CHB group to 1077.30 IU/ml in LC group and 789.72 IU/ml in HCC group,indicating a significant difference (x2= 15.643,P ＜ 0.01).Among HBeAg negative patients,HBsAg titre declined from 1669.00 IU/ml in CHB group to 1001.64 IU/ml in LC group and 582.05 IU/ml in HCC group,suggesting of a significant difference (x2= 6.423,P ＜ 0.05).Positive correlation between HBsAg titre and HBV DNA was found in CHB (r = 0.297,P＜ 0.05),LC(r = 0.346,P ＜ 0.05) and HCC( r = 0.452,P ＜ 0.05),respectively.Conclusion HBsAg titre level in serum decreased progressively from CHB to LC and HCC group.There were positive correlations between HBsAg titre and HBV DNA level in CHB,LC and HCC.