摘要
目的探讨处于免疫清除期（IC）的慢胜乙型肝炎（CHB）患者血清HBsAg水平与肝组织炎症分级和纤维化分期的关系。方法2009年3月至2011年6月确诊为IC期的CHB患者，同步进行肝组织病理学检查、血清HBsAg定量及生物化学指标检测。Spearman等级相关分析法判断HBsAg水平与肝组织炎症分级和纤维化分期之间的相关性；logistic回归分析法分析相关指标的诊断意义，并构建肝脏纤维化诊断预测模型，受试者工作曲线（ROC）法评价模型的诊断价值。结果共165例IC期CHB患者纳入本研究。炎症G1、G2、G3、G4级患者的血清HBsAg水平分别为（27716．07±32870．69）IU／ml、（34478．75±40899．55）Iu／ml、（19408．09±24881．07）Iu／ml、（14286．31±28610．14）IU／ml，G2、G3、G4级患者间HBsAg水平差别有统计学意义（X2=10．508，P〈0．05）；纤维化S1、S2、S3、s4期的血清HBsAg水平分别（41337．23±43236．39）IU／ml、（27264．32±32517．29）IU／ml、（11541．77±11538．93）IU／ml、（11447．37±22215．44）IU／ml，不同纤维化分期患者的HBsAg水平差异有统计学意义（x2=22．005，P〈0．01）。Spearman等级相关分析结果显示，HBsAg水平与炎症分级及纤维化分期均呈负相关关系（r值分别为-0．244和-0．365，P值均〈0．01）。HBsAg≤32995IU／ml判断纤维化s≥4的特异度为95．16％，灵敏度35．92％。二元logistic回归分析结果显示，年龄、白蛋白、胆碱酯酶和HBsAg水平的组合模型有助于判断s≥4，建立诊断模型：S=6．3087＋0．0492×年龄（岁）-0．5827×HBsAg（log10IU／ml）-0．1109×白蛋白（g／L）-0．0003×胆碱酯酶（IU／L），其灵敏度为75．73％，特异度为69．35％。结论Ic期CHB患者的血清HBsAg水平与肝脏炎症分级和纤维化分期呈负相关关系，且随病理分级的增加而呈阶梯状降低。HBsAg水平可作为无创性判断肝脏纤维化状态的一项重要指标。
Objective To investigate whether the level of hepatitis B surface antigen （HBsAg） represents the status of inflammation and stages of fibrosis in livers of patients with chronic hepatitis B （CHB） during the immune clearance phase （IC）. Methods Liver biopsy samples and sera were collected from 165 consecutive patients （136 males; 29 females） with CHB in IC who were treated in our hospital between March 2009 and June 2011. Routine biochemical tests were carried out to measure indicators of liver ftmction. The relation between HBsAg level and liver pathological stages were determined by Spearman＇s rank correlation analysis. The receiver operating characteristic （ROC） curve was used to evaluate the diagnostic value of HBsAg level for liver pathological stages. Binary logistic regression was used to analyze potentially relevant indicators, and liver pathology-predicting models were built and analyzed by the ROC method. Results The mean values of HBsAg （IU/mL） were significantly different at the different liver inflammation stages： G1, 27716.07 ± 32870.69; G2, 34478.75 ± 40899.55; G3, 19408.09 ± 24881.07; G4, 14286.31 ± 28610.14. Likewise, the mean values of HBsAg （IU/mL） were significantly different at the different liver fibrosis stages： S1, 41337.23 ± 43236.39; S2, 27264.32 ± 32517.29; S3, 111541.77 ± 11538.93; S4, 11447.37 ± 22 215.44. Spearman＇s rank correlation analysis indicated a significant correlation between HBsAg level and liver inflammation stage （rs = -0.244） and fibrosis stage （rs = -0.365）. ROC curve analysis of the diagnostic value of HBsAg for inflammation stages S ≥ 4 revealed that the area under the curve （AUC） was 0.70. The specificity of diagnosing S ≥ 4 was 〉 95.16% when HBsAg was ≤32995 IU/mL. Binary logistic regression analysis identified age, serum albumin, cholinesterase, and HBsAg as independent predictors of liver fibrosis. Conclusion HBsAg level is negatively correlated with liver inflammation and fibrosis stages for patients with CHB in the IC phase, and might represent a useful noninvasive marker of the degree of hepatic fibrosis.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2012年第10期746-750,共5页
Chinese Journal of Hepatology
关键词
肝炎病毒
乙型
肝炎表面抗原
肝硬化
炎症
免疫清除期
诊断模型
Hepatitis B Virus
Hepatitis B surface antigens
Liver cirrhosis
Inflammation
Immune clearance phase
Models, diagnosis
