摘要
目的:探讨乙型肝炎病毒DNA(hepatitis B virus DNA,HBV-DNA)载量水平与血清学标志物(hepatitis B virus markers,HBVM)分组模式以及前S1抗原(Pre-S1 antigen,Pre-S1Ag)的关系。方法:收集2018年6月至2020年7月来院就诊的180例慢性乙肝患者的血清样本,采用实时荧光定量聚合酶链反应(qRT-PCR)技术检测血清HBV-DNA载量水平;采用化学发光免疫分析法(CLIA)检测乙肝表面抗原(HBsAg)、e抗原(HBeAg)、表面抗体(抗HBs)、e抗体(抗HBe)、核心抗体(抗HBc),并归纳受检样本的HBVM分组模式;采用ELISA法检测血清Pre-S1Ag。分析HBV-DNA载量水平、HBVM分组模式和Pre-S1Ag水平的关系。结果:180例血清样本,HBsAg^(+)/抗HBe^(+)/抗HBc^(+)模式85例(47.22%),HBsAg^(+)/HBeAg^(+)/抗HBc^(+)模式70例(38.89%),其他模式25例(13.89%)。HBsAg^(+)/HBeAg^(+)/抗HBc^(+)模式组HBV-DNA、Pre-S1Ag阳性率均明显高于HBsAg^(+)/抗HBe^(+)/抗HBc^(+)模式组及其他模式组,差异有统计学意义(χ^(2)=56.955、46.809,P<0.05)。将HBV-DNA阳性作为判断HBV复制的金标准,HBeAg的灵敏度为87.23%,特异度为65.12%,阳性预测值为73.21%,阴性预测值为82.35%;Pre-S1Ag的灵敏度为90.35%,特异度为86.36%,阳性预测值为91.96%,阴性预测值为83.82%。依据HBV-DNA载量检测水平,分成<10^(3) copies/mL、10^(3)~10^(5) copies/mL、10^(5)~10^(7) copies/mL、>10^(7)copies/mL的4个亚组。随着HBV-DNA载量水平升高,Pre-S1Ag阳性率逐渐升高,分别为41.18%、64.00%、77.78%、94.29%,差异具有统计学意义(χ^(2)=31.250,P<0.05)。结论:HBV血清学标志物和Pre-S1Ag均可用于辅助诊断是否感染HBV以及HBV复制水平,但尚不可取代HBV-DNA定量检测,三者联合检测能为临床诊断、病毒复制提供更全面的依据。
Objective:To explore the relationship between hepatitis B virus(HBV)DNA(HBV-DNA)load levels and grouping mode of serological markers of hepatitis B(HBVM)and Pre-S1 antigen(Pre-S1Ag).Methods:Serum samples were collected from 180 patients with chronic hepatitis B who came to the hospital for treatment between June 2018 and July 2020.Serum HBV-DNA load levels were detected by quantitative real-time polymerase chain reaction(qRT-PCR).Hepatitis B surface antigen(HBsAg),hepatitis e antigen(HBeAg),surface antibody(anti-HBs),e antibody(anti-HBe)and core antibody(anti-HBc)were detected by chemiluminescence immunoassay(CLIA),and the HBVM grouping mode of the samples was summarized.Serum Pre-S1Ag was detected by enzyme linked immunosorbent assay(ELISA).The relationship between HBV-DNA load levels,HBVM grouping mode and Pre-S1Ag level was analyzed.Results:Among the 180 serum samples,there were 85 cases(47.22%)of HBsAg^(+)/anti-HBe^(+)/anti-HBc^(+)mode,70 cases(38.89%)of HBsAg^(+)/HBeAg^(+)/anti-HBc^(+)mode and 25 cases(13.89%)of other modes.The positive rates of HBV-DNA and Pre-S1Ag in HBsAg^(+)/HBeAg^(+)/anti-HBc^(+)mode group were significantly higher than those in HBsAg^(+)/anti-HBe^(+)/anti-HBc^(+)mode group and other mode group(χ^(2)=56.955,46.809,P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of HBeAg were 87.23%,65.12%,73.21%and 82.35%respectively when positive HBV-DNA was used as the gold standard for judging HBV replication.The sensitivity,specificity,positive predictive value and negative predictive value of Pre-S1Ag were 90.35%,86.36%,91.96%and 83.82%respectively.According to the HBV-DNA load detection levels,the patients were divided into four subgroups,including<10^(3) copies/mL,10^(3)–10^(5) copies/mL,10^(5)–10^(7) copies/mL and>10^(7) copies/mL subgroups.With the increase of HBV-DNA load levels,the positive rate of Pre-S1Ag was gradually increased,which were 41.18%,64.00%,77.78%and 94.29%respectively,with a statistically significant difference(χ^(2)=31.250,P<0.05).Conclusion:Both serological markers of HBV and Pre-S1Ag can be used to assist in the diagnosis of HBV infection and HBV replication levels,but they cannot replace HBV-DNA quantitative detection,and the combined detection of the three indicators can provide a more comprehensive basis for clinical diagnosis and viral replication.
作者
沙启明
SHA Qiming(Department of Clinical Laboratory,Traditional Chinese Medicine Hospital of Lu’an,Lu’an Anhui 237000,China)
出处
《临床与病理杂志》
CAS
2022年第1期33-38,共6页
Journal of Clinical and Pathological Research
