乙型肝炎患者血清HBV-DNA载量与前S1抗原和e抗原关系探讨

目的探讨乙型肝炎患者血清病毒DNA（HBV—DNA）载量与前S1抗原（PreS1）、e抗原（HBeAg）的关系；评价PreS1的临床检测意义。方法30例健康对照者血清和272例未经抗病毒治疗的乙型肝炎患者血清，同时采用实时荧光定量PCR法测定HBV-DNA载量、ELISA法检测PreS1和HBeAg。结果健康对照HBV—DNA载量、PreS1和HBeAg均阴性。乙肝患者血清HBV—DNA〈10^3copies／ml150例，其中PreS1阳性81例（54．00％），HBeAg阳性10例（6．67％）；10^3～1065 copies／ml44例，其中PreS1阳性22例（50．00％），HBeAg阳性16例（36．36%）；10^5～10^8 copies／ml 68例，其中PreS1阳性59例（86．76％）．HBeAg阳性43例（63．24％）；〉10^8 copies／ml 10例，其PreS1和HBeAg均为阳性。以HBV—DNA载量10^3copies／ml为切割值，则PreS1和HBeAg的敏感性分别为74．59％．56．56％，特异性分别为46．00％、93．33％，阳性预测值分别为52．91％、87．34％，阴性预测值分别为69．00％、72．54％，准确率分别为58．82％、76．84％。结论随着HBV—DNA载量的升高，PreS1和HBeAg的检出率大幅提高；虽然PreS1判断HBV复制的敏感性高于HBeAg，但其特异性、阳性预测值、阴性预测值、准确率均低于HBeAg。

Study relation between the level of serum HBV-DNA and PreS1 and HBeAg

Objective To study the relation between the level of serum HBV-DNA and PreS1 and HBeAg and to evaluate the clinical significance of PreS1.Methods Thirty healthy controls and 272 patients with chronic hepatitis B never treated with anti-viral therapy were selected.Serum level of HBV-DNA was determined by real-time fluorescence quantity PCR.Serum PreS1 and HBeAg were determined by ELISA.Results Serum HBV-DNA,PreS1 and HBeAg of healthy controls were all negative.Among 150 patients with serum level of HBV-DNA<10~3 copies/ml PreS1 of 81 patients(54.00%) was positive and HBeAg of 10 patients(6.67%) was positive.Among 44 patients with serum level of HBV-DNA 10~3-5 copies/ml PreS1 of 22 patients(50.00%) was positive and HBeAg of 16 patients(36.36%) was positive.Among 68 patients with serum level of HBV-DNA 10~5-8 copies/ml PreS1 of 59 patients(86.76%) was positive and HBeAg of 43 patients(63.24) was positive.Among 10 patients with serum level of HBV-DNA>10~8 copies/ml PreS1 and HBeAg of all patients were positive.If the level of HBV-DNA 10~3 copies/ml was suggested as cut-off value,the sensitivities of PreS1 and HBeAg were 74.59% and 56.56%,specificities were 46.00% and 93.33%,positive predict values were 52.91% and 87.34%,negative predict values were 69.00% and 72.54%,accuracy rates were 58.82% and 76.84% respectively.Conclusion The positive rates of PreS1 and HBeAg ignificantly increase as the level of HBV-DNA rises.Although the sensitivity of PreS1 is higher than that of HBeAg the specificity,positive predict value,negative predict value and accuracy rate are all lower than that of HBeAg.