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目的探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者HBsAg/HBV DNA比率的临床意义。方法收集46例轻中度慢性乙型肝炎(CHB-LM)患者、24例重度慢性乙型肝炎(CHB-S)患者和28例乙型肝炎肝硬化(HBV-LC)患者入院时及40例CHB患者治疗12周的外周血;采用全自动生化仪检测谷丙转氨酶(ALT)、总胆红素(TBil)等指标,化学发光法定量检测HBsAg水平,实时荧光PCR定量检测HBV DNA。结果 HBV-LC组HBsAg和HBV DNA均明显低于CHBLM(Z=-3.416和-2.636,均P<0.05)、CHB-S组(Z=-2.499和-2.407,均P<0.05),HBsAg/HBV DNA比率均稍高于CHB-LM、CHB-S组(均P>0.05);CHB-LM和CHB-S组之间比较无统计学差异(Z=-0.649、-0.032和-0.885,均P>0.05)。HBeAg阴性组的HBsAg、HBV DNA水平均高于HBeAg阳性组(Z=-2.662和-4.950,P=0.008和<0.001),HBsAg/HBV DNA比率较HBeAg阳性组明显升高(Z=-2.544,P=0.011)。治疗12周与治疗前比较,完全应答组HBsAg、HBV DNA均明显下降(Z=-2.103和-3.297,P=0.035和0.0002),HBsAg/HBV DNA比率明显升高(Z=-3.233,P=0.01);部分应答组HBV DNA明显下降(Z=-2.666,P=0.005),HBsAg/HBV DNA比率明显升高(Z=-2.666,P=0.000 4),HBsAg水平稍下降(Z=-1.600,P=0.110);无应答组HBV DNA明显下降(Z=-3.059,P=0.023),HBsAg稍下降(Z=-0.341,P=0.733),但HBsAg/HBV DNA比率升高(P>0.05)。HBsAg/HBV DNA比率与PLT(r=0.561,P=0.002)呈明显正相关。HBsAg/HBV DNA比率预测病毒学完全应答的曲线下面积AUC(0.643)高于HBsAg(0.580)和HBVDNA(0.433)。结论进展性HBV-LC和HBeAg阴性CHB患者HBsAg/HBV DNA比率偏高,且升高的HBsAg/HBV DNA比率与抗HBV治疗疗效欠佳有关。
Objective To investigate the clinical significance of HBsAg / HBV DNA in patients with chronic hepatitis B virus (HBV) infection. Methods Forty-six patients with mild-to-moderate chronic hepatitis B (CHB-LM), 24 patients with severe chronic hepatitis B (CHB-S) and 28 patients with hepatitis B cirrhosis (HBV-LC) The peripheral blood of CHB patients was treated for 12 weeks. The indexes of alanine aminotransferase (ALT) and total bilirubin (TBil) were detected by automatic biochemical analyzer. The levels of HBsAg were detected by chemiluminescence and quantitatively detected by real-time fluorescence PCR. Results The levels of HBsAg and HBV DNA in HBV-LC group were significantly lower than those in CHBLM group (both Z = -3.416 and -2.636, both P <0.05) (P> 0.05). There was no significant difference between CHB-LM group and CHB-S group (Z = -0.649, -0.032 and -0.885, both P> 0.05). The HBsAg and HBV DNA levels in HBeAg negative group were significantly higher than those in HBeAg positive group (Z = -2.662 and -4.950, P = 0.008 and <0.001) P = 0.011). The HBsAg and HBV DNA were significantly decreased in the complete response group after 12 weeks of treatment (Z = -2.103 and -3.297, P = 0.035 and 0.0002, respectively), and the HBsAg / HBV DNA ratio was significantly increased (Z = -3.233, P = 0.01). HBsAg / HBV DNA was significantly increased in the partial response group (Z = -2.666, P = 0.005) , P = 0.110). HBsAg slightly decreased (Z = -0.341, P = 0.733), but HBsAg / HBV DNA increased significantly in non-responder group (P = ). HBsAg / HBV DNA ratio was positively correlated with PLT (r = 0.561, P = 0.002). The area under the curve for the ratio of HBsAg / HBV DNA predicted for virologic complete response was higher (AUC 0.643) than HBsAg (0.580) and HBVDNA (0.433). Conclusions The rate of HBsAg / HBV DNA in patients with progressive HBV-LC and HBeAg-negative CHB is high, and the elevated HBsAg / HBV DNA ratio is associated with poor response to anti-HBV therapy.