前S1抗原在乙型肝炎诊断中的应用研究

目的研究在不同病情乙肝患者血清中前S1抗原（HBVpre-S1）水平的变化与HBV血清标志物、HBV-DNA的临床相关性，评价HBVpre—S1的检测在乙型肝炎诊断中的应用价值。方法用酶联免疫吸附法（ELISA）分别对268例HBV血清进行五项血清标志物，Pre—S1的检测。用全自动生化分析仪赖氏法检测肝功能，同时采用PCR荧光定量法检测HBV-DNA的量。结果196例慢性乙肝（CH）患者中，HBeAg（＋）组和HBeAg（-）组比较，Pre-S1（＋）和HBVDNA（＋）检出率及Pre-S1／HBsAg的相对比值均高于HBeAg（-）组，差异具有统计学意义P〈0．01；且在HBeAg（-）组中。HBeAb（-）组和HBeAb（＋）组相比，Pre-S1／HBsAg相对比值也显著高于HBeAb（＋）组，P〈0．05；在CH患者中，轻、中、重三组间的Pre-S1（＋）率，HBVDNA及Pre-S1／HBsAg相对比值相比较，差异均无统计学意义，且Pre-S1／HBsAg相对比值水平和肝脏炎症程度无关。在72例AH患者中，Pre-S1／HBsAg的相对比值与肝脏急性损伤的严重程度相关，在AH患者Pre-S1／HBsAg相对比值水平下降越早越快，病程越短，预后越好。结论Pre-S1可作为HBV复制的标志物；而Pre-S1／HBsAg的相对比值的高低，在肝炎的诊断，AH预后的判断方面具有重要的价值；联合检测Pre-S1可补充和完善HBV五项检测的不足，尤其对HBeAg（-）或者变异的HBV感染者能更好地反映病毒的复制状态和传染性。

Hepatitis B pre-S1 antigen in the Diagnosis

Objective To study the serum of patients with different disease Hepatitis B antigen pre-S1 (HBVpre-S1) levels in patients with HBV serum markers, HBV-DNA of the clinical relevance, evaluation HB-Vpre-S1 the detection of hepatitis diagnosis value. Methods Used enzyme linked immunosorbent assay (ELISA) were conducted on 268 cases of the five serum HBV serum markers, Pre-S1 test. Automatic biochemical analyzer Lai liver function was detected, anddetected by fluorescence quantitative PCR HBV-DNA quantity. Results 196 patients with chronic hepatitis B (CH) patients, HBeAg (+) group, and HBeAg (-) group, Pre-S1(+)and HBVDNA(+)detection rate and the relative ratio of both high Pre-S1/HBsAg in HBeAg(-) group,the difference was significant,P ＜0. 01 ;and in HBeAg(-) group. HBeAb(-) group and HBeAb(+)group compared to, Pre-S1/HBsAg relative ratio was also significantly higher than HBeAb(+)group,P ＜ 0. 05. In CH patients, mild,moderate and severe among the three groups of Pre-S1 (+)rate, HBVDNA and Pre-S1/HBsAg relative ratio,the difference was not statistically significant, and the relative ratio Pre-S1/HBsAg levels and liver inflammation grade. In the 72 cases of AH patients,Pre-S1/HBsAg the relative ratio and the severity of liver acute injury related to the ratio of AH relative decline in patients with earlier Pre-S1/HBsAg faster, shorter course of disease,better prognosis. Conclusion Pre-S1 can be used as a marker of HBV replication,and Pre-S1/HBsAg the relative ratio of height,in the diagnosis of hepatitis, AH has important prognostic value. Detection Pre-S1 can be combined to complement and improve the HBV less than five detection, particularly for HBeAg (-)or a variation of HBV infection to better reflect the state of viral replication and infectious.