慢性乙型肝炎病毒感染者前S1抗原和抗体检测的临床意义

目的 探讨前S1抗原(PreS1Ag)与前S1抗体（抗-PreS1）在慢性HBV感染者中的检出情况及其临床意义。方法 收集慢性HBV感染者428例，检测HBV血清学标志物、HBV DNA及PreS1Ag、抗-PreS1，分析PreS1Ag、抗-PreS1在慢性HBV感染不同转归人群[即e抗原阳性慢性乙型肝炎(CHB)组、e抗原阴性CHB组、非活动性HBsAg携带组、HBsAg血清学转换组]的检出情况及临床意义;同时分析PreS1Ag、抗-PreS1与HBV标志物、HBV DNA的关系。用SPSS13.0软件进行统计学处理。计数资料采用四格表或配对x2检验，计量资料采用独立样本t检验或秩和检验进行数据分析。结果 PreS1Ag阳性率e抗原阳性CHB组为95.7％(67/70)、e抗原阴性CHB组为82.8％ (24/29)、非活动性HBsAg携带组为13.2％(7/53)、HBsAg转换组为2.2％ (1/46)，四组人群PreS1Ag阳性率依次下降,x2=141.7,P＜0.05，总体比较差异有统计学意义，可见PreS1Ag阳性率随病毒复制活跃程度下降而降低。抗-PreS1在四组间检出率差异无统计学意义。将HBsAg阳性的前三组（即e抗原阳性CHB组、e抗原阴性CHB组、非活动性HBsAg携带组）合并为一组，再与HBsAg血清学转换组比较，抗-PreS1阳性率分别为0.9％(14/152)和23.9％0 (14/46)，x2 =6.919，P＜0.05，差异有统计学意义。PreSl Ag的吸光度值的平均秩次在高复制组为179.30，低复制组为133.80，高复制组明显高于低复制组,Z=-3.86，P＜0.05，差异有统计学意义;虽两组抗-PreS1的吸光度值平均秩次差异无统计学意义，但低复制组(23.86)较高复制组(21.08)有升高趋势。通过配对计数X2检验分析抗-HBs与抗-PreS1的吻合性，x2=0.262,P＞0.05，两者检出率差异无统计学意义。血清PreS1Ag、HBeAg、肝组织内HBcAg与HBV DNA有关联性，x2值分别为33.840、24.159、4.854，P值均＜0.05。血清PreS1Ag与HBV DNA的关联程度(r=0.628)高于HBeAg(r=0.563)。 结论PreS1Ag较HBeAg更敏感的反映了HBV复制的情况，抗-PreS1可能参与了HBV的清除，预示着慢性乙型肝炎的恢复。

The clinical significance of PreS1Ag and anti-PreSl in patients with chronic hepatitis B

Objective To investigate the positive ratio and clinical significance of PreS1Ag and anti-PreS1 in patients with chronic hepatitis B. Methods 428 patients with chronic HBV infection were collected, these patients were divided into e antigen-positive CHB group, e antigen-negative CHB group, inactive HBsAg carrier group and HBsAg serum conversion group. The difference of positive ratio of PreSlAg and anti-PreSl among all groups or between every two groups were analyzed; The relationship of PreS1Ag and anti-PreSl with HBV M and HBV DNA were also analyzed. SPSS13,0 softwar was used for statistical treatment. Fourfold table chi-square test or matched-pairs chi-square test was used for enumeration data, and independent sampler t test or rank-sum test was used for measurement data. Results The differences of PreS1Ag among four groups were statistically significant ( x2 =141.7, P ＜ 0.05). The positive ratio of PreS1Ag in e antigen-positive CHB group was 95.7％, followed by 82.8％ in e antigen-negative CHB group, 132.％ in inactive HBsAg carrier group and 2.2％ in HBsAg serum conversion group. The difference of positive ratio of anti-PreS1 between HBsAg seroconversion group and HBsAg positive group was statistically significant (x 2 =6.919, P ＜ 0.05), which indicated that anti-PreSl had good correlation with HBsAg seroconversion. The average absorbance ratio of PreS 1Ag in high viral replication group ( 179.30 ) was higher than that in low viral replication group (133.87), statistical significance appeared (Z =-3.86, P ＜ 0.05). Though the difference of absorbance ratio of anti-PreSl between two groups had no statistical significance (P ＞ 0.05), descent trend was apparent with virus replication level ascending. We analyzed the concordance of anti-HBs and anti-PreS1 by matched-pairs chi-square test, result showed no statistical significance of detection rate between them, x2=0.262, P＞ 0.05. Serum PreS1Ag, HBeAg or HBcAg in liver tissue in reflecting hepatitis B replication had correlation with HBV DNA ( x 2=33.840、 24.159、 4.854 in order, P ＜ 0.05). Correlation coefficient between PreS1Ag and HBV DNA was higher (r =0.628) than that between HBeAg and HBV DNA (r =0.563). Conclusion PreS1Ag was more sensitive than HBeAg in diagnosing viral replication in patients with chronic hepatitis B. Anti-PreS 1 as protective antibody may be involved in clearance of hepatitis B, positive result indicated recovery of chronic hepatitis B.