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

孙超; 常秀娟; 李晓东; 杨永平

doi:10.3969/j.issn.1001-5256.2019.02.017

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

DOI: 10.3969/j.issn.1001-5256.2019.02.017

1. 北京大学三〇二临床医学院
2. 解放军第三〇二医院肝脏肿瘤诊疗与研究中心
3. 解放军医学院
4. 解放军第三〇二医院临床研究管理中心

基金项目:

国家“十二五”科技重大专项(2013ZX10005002)；

详细信息

中图分类号: R512.62;R575.2
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出版历程
- 出版日期: 2019-02-20

Value of hepatitis B virus core-related antigen in predicting the natural course of chronic hepatitis B and liver fibrosis regression

Peking University 302 Clinical Medical School

Research funding:

摘要

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（AU...
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 乙型肝炎核心相关抗原 /
- 生物学标记
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 of0. 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.
- hepatitis B, chronic /
- liver cirrhosis /
- hepatitis B core-related antigen /
- biological markers

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