高发区肝癌患者血清乙型肝炎病毒HBV标志物和HBV DNA水平比较分析

目的 探讨高发区原发性肝癌血清中乙型肝炎病毒(HBV)的感染标志(HBVM)状态和核酸(HBVDNA)水平及相互关系.方法 采用酶联免疫吸附测定(ELISA)法和荧光定量聚合酶链反应(PCR)法对江苏省启东地区211例原发性肝癌(肝癌组)和229例HBV感染者(对照组)进行HBVM和HBV DNA含量检测.结果 肝癌组HBV感染率高达99.5%,两组HBV DNA阳性率分别为70.0%和66.4%(P>0.05).肝癌组HBsAg阳性率显著低于对照组,85.2% vs 93.9%(P<0.05),这类患者HBV DNA检出率显著高于对照组,79.9% vs 69.3%(P<0.05),但其中栽量≥106 copies/ml检出率显著低于对照组,28.0%vs 40.3%(P<0.05).HBVM模式主要有HBsAg/HBeAg/抗-HBc阳性、HBsAg/抗-HBe/抗-HBc阳性和HBsAg/抗-HBc阳性3种,它们在两组中的分布差异有统计学意义(P<0.01),对照组中HBsAg、抗-HBe、抗-HBc阳性模式最常见(41.5%),而肝癌组中HBsAg/抗-HBc阳性者最多(35.7%),且其HBV DNA阳性率和平均水平都显著高于对照组(P<0.05).结论 启东地区原发性肝癌患者HBV感染率很高,多数处于中低水平的HBV复制活跃期,这可能增加了HBV DNA的肝内整合机会,最终导致癌变的发生;启东肝癌患者HBVM以HBsAg/抗-HBc阳性最多见,HBVe系统的缺失是否暗示有特定变异的存在值得作进一步的研究.

Study on relationships between HBV markers and HBV DNA levels of primary liver cancer patients in Qidong region

Objective To investigate the features and relationships of HBV markers and HBV DNA levels in primary liver cancer（PLC） patients of the Qidong high risk region. Methods Serum HBV markers and HBV DNA levels of 211 PLC patients and 229 HBV infected cases were detected by ELISA and FQ-PCR methods, respectively. Results 99.5% of the PLC patients were infected by HBV,and the HBV DNA positive rate of two groups was 70.0% and 66.4%,respectively（ P 〉0.05）. PLC group showed a significantly lower HBsAg positive rate than the control group, 85.2 % vs 93.9 % （ P 〈0.05）, the HBV DNA positive rate of those patients was significantly higher than that of the control group,79.9% vs 69.3%（ P d0.05）. The rate of HBV DNA level ≥104 copies/ml was significantly lower than that of the control group, 28. 0% vs 40. 3% （ P 〈0.05）. The distributions of the three most common HBVM patterns were significantly different between the two groups（ P 〈0.01）. HBsAg/anti-HBe/anti-HBc＋ was the most common HBVM pattern in the control group（41.5 %）, while HBsAg/anti-HBc＋ in the PLC group（35.7% ）, and the HBsAg/anti-HBc＋ PLC patients had significantly higher HBV DNA positive rate and higher average level than the control（ P 〈0.05）. Conclusion PLC patients of Qidong region endure serious HBV infections. Most of them suffer from HBV DNA replications that are active but not too high,which may enhance the HBV DNA insertion and finally induce the carcinogenesis. HBsAg/anti-HBc＋ is the most common HBVM pattern in Qidong PLC, the absence of the HBVe system may suggest the existence of some special mutations.