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HBcrAg在慢性乙型肝炎自然进程及预判肝纤维化逆转中的应用价值
Value of hepatitis B virus core-related antigen in predicting the natural course of chronic hepatitis B and liver fibrosis regression
文章发布日期:2019年01月07日  来源:  作者:孙超,常秀娟,李晓东,等  点击次数:357次  下载次数:97次

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【摘要】:目的 评价HBV核心相关抗原(HBcrAg)预测慢性乙型肝炎(CHB)肝纤维化分级及逆转的临床应用价值。方法 选取2013年1月-2015年12月解放军第三〇二医院、郑州大学第一附属医院和福州市传染病医院收治的CHB患者,其中HBeAg阳性69例、HBeAg阴性69例。109例Ishak评分≥3的患者接受恩替卡韦治疗72周。收集基线及72周治疗后两次肝活组织标本和血清,检测组织病理及HBcrAg水平。符合正态分布的计量资料两组间比较采用t检验;不符合正态分布的计量资料两组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验。相关性分析采用Spearman相关分析法。采用受试者工作特征曲线分析HBcrAg对肝纤维化的诊断价值。结果 在HBeAg阳性CHB患者中,血清HBcrAg水平与肝纤维化进程呈负相关(r=-0.342,P=0.004);在HBeAg阴性CHB患者中,血清HBcrAg水平与肝纤维化进程及炎症改变均呈正相关(r值分别为0.439、0.437,P值均<0.001)。HBeAg阳性患者血清HBcrAg预测晚期肝纤维和肝硬化的受试者工作特征曲线下面积(AUC)分别为0.705、0.701(P值均<0.05),HBeAg阴性患者血清HBcrAg预测轻微肝纤维化、明显肝纤维化、晚期肝纤维化和肝硬化的AUC分别为0.815、0.815、0.726、0.675(P值均<0.05)。经抗病毒治疗后,基线血清HBcrAg高表达组较低表达组更易发生肝纤维化逆转(53.7% vs 32.7%, χ2=4.888,P=0.027)。肝纤维化逆转患者血清HBcrAg下降差值高于未逆转患者[1.5(0.4~3.2) log IU/ml vs 0.8(0.1~1.8) log IU/ml,Z=-1.724, P=0.042]。结论 血清HBcrAg可作为预测CHB肝纤维化分级和判定肝纤维化逆转的一项有临床应用价值的新标志物。
【Abstract】:Objective To investigate the clinical value of hepatitis B virus core-related antigen (HBcrAg) in predicting the natural course of chronic hepatitis B (CHB) and liver fibrosis regression. Methods A total of 138 CHB patients who were admitted to 302 Hospital of PLA, The First Affiliated Hospital of Zhengzhou University, and Fuzhou Infectious Disease Hospital from January 2013 to December 2015 were enrolled and divided into HBeAg-positive group with 69 patients and HBeAg-negative group with 69 patients. Of all patients, 109 with an Ishak score of ≥3 were treated with entecavir for 72 weeks. Liver biopsy specimens and serum were collected at baseline and after 72 weeks of treatment to observe histopathology and HBcrAg level. The t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two group. The chi-square test was used for comparison of categorical data between groups. A Spearman correlation analysis was also performed. The area under the receiver operating characteristic curve (AUC) was used to analyze the value of HBcrAg in the diagnosis of liver fibrosis. Results In HBeAg-positive CHB patients, serum HBcrAg level was negatively correlated with liver fibrosis stage (r=-0.342, P=0.004); in HBeAg-negative CHB patients, serum HBcrAg level was positively correlated with liver fibrosis stage and inflammation (r=0.439 and 0.437, both P<0.001). In HBeAg-positive patients, serum HBcrAg level had an AUC of 0.705 in predicting advanced liver fibrosis and 0.701 in predicting liver cirrhosis (both P<0.05); in HBeAg-negative CHB patients, serum HBcrAg level had AUCs of 0815, 0.815, 0.726, and 0.675 in predicting mild liver fibrosis, marked liver fibrosis, advanced liver fibrosis, and liver cirrhosis, respectively (all P<0.05). After antiviral therapy, the group with a high serum HBcrAg level was more likely to experience liver fibrosis regression than that with a low level (53.7% vs 32.7%, χ2=4.888, P=0.027). The patients with liver fibrosis regression had a significantly greater reduction in serum HBcrAg level than those without regression[1.5 (0.4-3.2) log IU/ml vs 0.8 (0.1-1.8) log IU/ml, Z=-1.724, P=0.042]. Conclusion Serum HBcrAg can be used as a new marker in predicting liver fibrosis stage and liver fibrosis regression in clinical practice.
【关键字】:肝炎, 乙型, 慢性; 肝硬化; 乙型肝炎核心相关抗原; 生物学标记
【Key words】:hepatitis B, chronic; liver cirrhosis; hepatitis B core-related antigen; biological markers
【引证本文】:SUN C, CHANG XJ, LI XD, et al. Value of hepatitis B virus core-related antigen in predicting the natural course of chronic hepatitis B and liver fibrosis regression[J]. J Clin Hepatol, 2019, 35(2): 328-333. (in Chinese)
孙超,常秀娟,李晓东,等. HBcrAg在慢性乙型肝炎自然进程及预判肝纤维化逆转中的应用价值[J]. 临床肝胆病杂志, 2019, 35(2): 328-333.

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