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HBsAg水平对ALT正常的HBeAg阳性慢性HBV感染者肝脏炎症发生的预测价值

曾湛 高媛娇 毕潇月 陈凤欣 邓雯 蒋婷婷 林妍洁 杨柳 李明慧 谢尧

引用本文:
Citation:

HBsAg水平对ALT正常的HBeAg阳性慢性HBV感染者肝脏炎症发生的预测价值

DOI: 10.3969/j.issn.1001-5256.2022.05.011
基金项目: 

北京市医管中心临床专项项目 (XMLX201706)

北京市医管中心临床专项项目 (XMLX 202127)

国家科技重大专项 (2017ZX10201201-001-006)

国家科技重大专项 (2017ZX10201201-002-006)

国家科技重大专项 (2018ZX10715-005-003-005)

首都卫生发展专项公共卫生项目 (2021-1G-4061)

首都卫生发展专项公共卫生项目 (2022-1-2172)

北京市医管中心消化协同中心资助项目 (XXZ0302)

北京市医管中心消化协同中心资助项目 (XXT28)

北京市科委课题 (D161100002716002)

首都临床特色专项资助项目 (Z151100004015122)

伦理学声明:本研究方案于2018年1月25日经由首都医科大学北京地坛医院伦理委员会批准,批号:201800201。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:谢尧、李明慧对研究思路和研究设计有关键贡献;陈凤欣、邓雯、蒋婷婷、林妍洁、杨柳收集和分析数据;高媛娇、毕潇月参与研究统计学方法的选择和文章的修改;曾湛负责撰写成文。
详细信息
    通信作者:

    谢尧,xieyao00120184@sina.com

    曾湛、高媛娇与毕潇月对本文贡献等同, 同为第一作者

Value of HBsAg level in predicting liver inflammation in patients with HBeAg-positive chronic hepatitis B virus infection and normal alanine aminotransferase

Research funding: 

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX201706);

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX 202127);

National Science and Technology Major Project of China (2017ZX10201201-001-006);

National Science and Technology Major Project of China (2017ZX10201201-002-006);

National Science and Technology Major Project of China (2018ZX10715-005-003-005);

Special Public Health Project for Health Development in Capital (2021-1G-4061);

Special Public Health Project for Health Development in Capital (2022-1-2172);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0302);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXT28);

Beijing Science and Technology Commission (D161100002716002);

Beijing Municipal Science & Technology Commission (Z151100004015122)

More Information
  • 摘要:   目的  探讨ALT正常且高病毒载量的HBeAg阳性慢性HBV感染者人群的肝炎发生情况及预测因素。  方法  本研究临床注册号为NCT04032275。回顾性选取2008年10月—2015年5月ALT正常、高病毒载量、HBeAg阳性的慢性HBV感染者183例,根据其肝穿刺活检结果分为肝炎组和无肝炎组。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验。使用单因素二元logistics回归分析预测因素,使用逐步后退法进行多因素二元logistics回归,使用受试者工作特征曲线(ROC)和约登指数分析截断值。  结果  肝炎组37例(20.2%),无肝炎组146例(79.8%),肝炎组的男性比例低于无肝炎组(45.9% vs 68.5%, χ2=6.508, P=0.011)、AST高于无肝炎组[24(21.25~35.55) U/L vs 21.2(18.08~24.65) U/L, Z=-3.344, P=0.001]、HBsAg log值低于无肝炎组[4.4(4.28~4.49) vs 4.46(4.4~4.74), Z=-2.184,P=0.029]。HBsAg log值是肝炎发生的预测因素(OR=0.077, P=0.017)。HBsAg的截断值为33 884.4 IU/mL。  结论  ALT正常、高病毒载量的HBeAg阳性患者中有20.2%肝脏存在炎症,HBsAg或许是肝脏炎症发生的预测因素。

     

  • 图  1  HBsAg定量log值的ROC曲线

    Figure  1.  ROC curve of log(HBsAg)

    图  2  AST的ROC曲线图

    Figure  2.  ROC curve of AST

    表  1  肝炎组与无肝炎组基线情况对比

    Table  1.   Comparisons of baseline between hepatitis group and non-hepatitis group

    指标 总体(n=183) 无肝炎组(n=146) 肝炎组(n=37) 统计值 P
    年龄(岁) 31.99±9.08 31.30±8.53 34.73±10.72 t=-1.806 0.077
    男性[例(%)] 117(63.9) 100(68.5) 17(45.9) χ2=6.508 0.011
    ALT(U/L) 28.20(22.00~33.70) 28.20(21.50~33.05) 28.30(23.10~35.10) Z=-0.836 0.403
    ALT分层比较[例(%)]
      <20 U/L 25(13.7) 21(14.4) 4(10.8) χ2=-0.185 0.853
      20~29.9 U/L 82(44.8) 65(44.5) 17(46.0) χ2=-0.498 0.619
      30~40 U/L 76(41.5) 60(41.1) 16(43.2) χ2=-1.230 0.219
    AST(U/L) 22.10(18.80~25.50) 21.20(18.08~24.65) 24.00(21.25~35.55) Z=-3.344 0.001
    TBil(μmol/L) 12.85(9.50~17.43) 12.60(9.40~17.75) 13.20(9.55~16.25) Z=-0.142 0.887
    Alb(g/L) 46.40(44.18~48.90) 46.40(44.30~48.85) 46.40(43.70~49.10) Z=-0.122 0.903
    WBC(×109/L) 5.91±1.34 5.94±1.28 5.76±1.58 t=0.698 0.486
    PLT(×109/L) 212.15±50.41 212.81±51.53 209.38±46.07 t=0.346 0.730
    PTA(%) 88.08±9.29 88.47±9.85 86.54±6.58 t=0.929 0.355
    HBV DNA(logIU/mL) 7.72(7.52~7.99) 7.72(7.5~8.01) 7.73(7.59~7.99) Z=-0.608 0.543
    HBsAg(logU/mL) 4.43(4.40~4.71) 4.46(4.40~4.74) 4.40(4.28~4.49) Z=-2.184 0.029
    HBeAg(S/CO) 1400.56(1246.11~1550.96) 1411.00(1269.70~1553.30) 1323.60(995.70~1519.30) Z=-1.899 0.058
    下载: 导出CSV

    表  2  单因素logistic回归分析肝炎危险因素

    Table  2.   Single factor logistic regression analysis of risk factors for hepatitis

    项目 B Wald P OR 95%CI
    性别(男性) -0.939 6.273 0.012 0.391 0.188~0.815
    年龄(岁) 0.040 4.111 0.043 1.041 1.001~1.082
    AST(U/L) 0.047 7.140 0.008 1.048 1.013~1.085
    HBsAg(logU/mL) -2.566 5.716 0.017 0.077 0.009~0.630
    HBeAg(S/CO) -0.002 7.349 0.007 0.998 0.997~1.000
    下载: 导出CSV
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  • 收稿日期:  2022-02-03
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