目的:分析乙肝“大三阳”和“小三阳”患者血清中HBV DNA载量、肝功能指标ALT和AST、肝纤维化标志物壳酶蛋白(CHI3L1)、肝癌标志物AFP。方法:选取448例乙肝患者作为研究对象,根据乙肝两对半结果分为两组:大三阳组(143例)、小三阳组(305例),对两组患者的血清HBV DNA载量、ALT、AST、CHI3L1、AFP结果进行分析。采用卡方检验分析组间差异。结果:大三阳组的HBV DNA和ALT水平均明显高于小三阳组(P < 0.05)。大三阳组的CHI3L1水平明显低于小三阳组(P < 0.05);CHI3L1水平在大三阳组和小三阳组均随年龄的升高而显著升高。随着HBV DNA载量的增加,两组患者的AFP水平逐渐升高;但相同的HBV DNA载量下,两组患者的AFP水平比较差异无统计学意义(P > 0.05)。结论:乙肝“大三阳”患者血清中HBV DNA载量和ALT明显高于“小三阳”患者,提示病毒复制更为活跃,传染性更强,肝功能损伤程度更高。肝癌标志物AFP与HBV DNA呈正相关,提示控制病毒载量的重要性。CHI3L1小三阳组反而高于大三阳组,提示肝纤维化与病程的相关性。 Objective: To analyze HBV DNA load, liver function indexes of ALT and AST, liver fibrosis marker CHI3L1 and liver cancer marker AFP in patients with HBsAg, HBeAg, and HBcAb test positive (HBsAg+/HBeAg+/HBcAb+) and HBsAg, HBeAb, and HBcAb test positive (HBsAg+/HBeAb+/HBcAb+). Methods: 448 patients with hepatitis B were divided into two groups according to serological results: patients with HBsAg+/HBeAg+/HBcAb+ (143 cases) and patients with HBsAg+/HBeAb+/HBcAb+ (305 cases). The results of serum HBV DNA load, ALT, AST, CHI3L1 and AFP in the two groups were analyzed. Chi-square test was used to analyze the differences be-tween groups. Results: The levels of HBV DNA and ALT in patients with HBsAg+/HBeAg+/HBcAb+ were significantly higher than those in HBsAg+/HBeAb+/HBcAb+ group (P < 0.05). The level of CHI3L1 in HBsAg+/HBeAg+/HBcAb+ group was significantly lower than that in HBsAg+/HBeAb+/HBcAb+ group (P < 0.05). The level of CHI3L1 increased significantly with age in both groups. With the increase of HBV DNA load, the AFP levels of patients in the two groups gradu-ally increased. However, under the same HBV DNA load, there was no significant difference in AFP level between the two groups (P > 0.05). Conclusion: The serum HBV DNA load and ALT in patients with HBsAg+/HBeAg+/HBcAb+ are significantly higher than those in patients with HBsAg+/HBeAb+/HBcAb+ group, indicating more active virus replication, stronger infectivity, and higher degree of liver function damage. Liver cancer marker AFP level was positively correlated with HBV DNA load, suggesting the importance of viral load control. The CHI3L1 in patients with HBsAg+/HBeAb+/HBcAb+ was higher than that in the HBsAg+/HBeAg+/HBcAb+ group, suggesting that the progress of liver fibrosis was associated with disease course.
目的:分析乙肝“大三阳”和“小三阳”患者血清中HBV DNA载量、肝功能指标ALT和AST、肝纤维化标志物壳酶蛋白(CHI3L1)、肝癌标志物AFP。方法:选取448例乙肝患者作为研究对象,根据乙肝两对半结果分为两组:大三阳组(143例)、小三阳组(305例),对两组患者的血清HBV DNA载量、ALT、AST、CHI3L1、AFP结果进行分析。采用卡方检验分析组间差异。结果:大三阳组的HBV DNA和ALT水平均明显高于小三阳组(P < 0.05)。大三阳组的CHI3L1水平明显低于小三阳组(P < 0.05);CHI3L1水平在大三阳组和小三阳组均随年龄的升高而显著升高。随着HBV DNA载量的增加,两组患者的AFP水平逐渐升高;但相同的HBV DNA载量下,两组患者的AFP水平比较差异无统计学意义(P > 0.05)。结论:乙肝“大三阳”患者血清中HBV DNA载量和ALT明显高于“小三阳”患者,提示病毒复制更为活跃,传染性更强,肝功能损伤程度更高。肝癌标志物AFP与HBV DNA呈正相关,提示控制病毒载量的重要性。CHI3L1小三阳组反而高于大三阳组,提示肝纤维化与病程的相关性。
乙型肝炎,大三阳,小三阳,HBV DNA,CHI3L1,ALT,AST,AFP
Xiaojuan Pan, Shengjun Wu*
Clinical Laboratory, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou Zhejiang
Received: Jul. 8th, 2022; accepted: Aug. 4th, 2022; published: Aug. 11th, 2022
Objective: To analyze HBV DNA load, liver function indexes of ALT and AST, liver fibrosis marker CHI3L1 and liver cancer marker AFP in patients with HBsAg, HBeAg, and HBcAb test positive (HBsAg+/HBeAg+/HBcAb+) and HBsAg, HBeAb, and HBcAb test positive (HBsAg+/HBeAb+/HBcAb+). Methods: 448 patients with hepatitis B were divided into two groups according to serological results: patients with HBsAg+/HBeAg+/HBcAb+ (143 cases) and patients with HBsAg+/HBeAb+/HBcAb+ (305 cases). The results of serum HBV DNA load, ALT, AST, CHI3L1 and AFP in the two groups were analyzed. Chi-square test was used to analyze the differences between groups. Results: The levels of HBV DNA and ALT in patients with HBsAg+/HBeAg+/HBcAb+ were significantly higher than those in HBsAg+/HBeAb+/HBcAb+ group (P < 0.05). The level of CHI3L1 in HBsAg+/HBeAg+/HBcAb+ group was significantly lower than that in HBsAg+/HBeAb+/HBcAb+ group (P < 0.05). The level of CHI3L1 increased significantly with age in both groups. With the increase of HBV DNA load, the AFP levels of patients in the two groups gradually increased. However, under the same HBV DNA load, there was no significant difference in AFP level between the two groups (P > 0.05). Conclusion: The serum HBV DNA load and ALT in patients with HBsAg+/HBeAg+/HBcAb+ are significantly higher than those in patients with HBsAg+/HBeAb+/HBcAb+ group, indicating more active virus replication, stronger infectivity, and higher degree of liver function damage. Liver cancer marker AFP level was positively correlated with HBV DNA load, suggesting the importance of viral load control. The CHI3L1 in patients with HBsAg+/HBeAb+/HBcAb+ was higher than that in the HBsAg+/HBeAg+/HBcAb+ group, suggesting that the progress of liver fibrosis was associated with disease course.
Keywords:Hepatitis B, HBsAg+/HBeAg+/HBcAb+, HBsAg+/HBeAb+/HBcAb+, HBV DNA, CHI3L1, ALT, AST, AFP
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
乙型肝炎是乙型肝炎病毒(hepatitis B virus, HBV)引起的常见的一种慢性传染病,HBV感染呈世界性流行,但不同地区HBV感染的流行强度差异很大。据WHO报道,全球约有2.57亿慢性HBV感染者,非洲地区和西太平洋地区占68%。中国是乙肝感染人口较多的国家,我国HBsAg流行率大于5% [
研究对象为2021年7月至2021年12月在本院就诊的448例乙肝患者,均符合《慢性乙肝防治指南》中的乙肝诊断标准,且研究的几项血清学指标检测完整者。根据血清学指标检测结果,参考乙肝分类标准分为两组:小三阳组305例,其中男191例、女114例,年龄22~75岁、平均(44.0 ± 11.0)岁,其中<50岁204例、≥50岁101例;大三阳组143例,其中男92例、女51例,年龄18~70岁、平均(35.5 ± 10.7)岁,其中<50岁120例、≥50岁23例。
HBV血清指标和AFP采用雅培ARCHITECT I2000SR全自动免疫分析系统,试剂均为雅培公司配套的原装试剂,按照标准操作规程进行操作。ALT、AST指标检测仪器选用Beckman Coulter AU5800,试剂为贝克曼原装试剂。HBV DNA检测仪器选用宏石SLAN-96S型检测仪,试剂由上海之江生物科技有限公司提供。CHI3L1检测试剂为杭州普望生物技术有限公司提供,使用宝特酶标仪。
1) 检测指标所有研究对象均行HBV DNA、CHI3L1、ALT、AST、AFP项目检测。
2) 分析方案对比分析两组患者乙肝血清学及生化指标差异;根据年龄分组,对比分析年龄与各项指标的关系;对比分析不同HBV DNA载量患者各项指标的关系。
用SPSS25.0软件处理数据。计数资料以例数或率表示,组间比较采用χ2检验;计量资料以M (P25, P75)表示,组间比较采用秩和检验;检验水准α = 0.05 ,以P < 0.05为差异有统计学意义。
1) 血清学及生化指标大三阳组的HBV DNA和ALT水平均明显高于小三阳组,差异有统计学意义(P < 0.05);大三阳组的CHI3L1水平明显低于小三阳组,差异有统计学意义(P < 0.05);两组患者的AFP和AST水平比较差异无统计学意义(P > 0.05)。见表1。
2) 年龄与各项指标的关系50岁以下大三阳组的HBV DNA和ALT水平均明显高于小三阳组,而CHI3L1水平明显低于小三阳组,差异有统计学意义(P < 0.05);50岁以上大三阳组和小三阳组各项标志物变化不大,差异无统计学意义(P > 0.05);CHI3L1水平在大三阳组和小三阳组均随年龄的升高而显著升高(P < 0.05)。见表2。
3) HBV DNA载量与各项指标的关系随着HBV DNA载量的增加,两组患者的AFP水平逐渐升高;但相同的HBV DNA载量下,两组患者的AFP水平比较差异无统计学意义(P > 0.05)。见表3。
进行HBV DNA载量和一些血清学指标检测能够帮助临床医生对乙肝患者的监测以及治疗,发挥着重要作用。“大三阳”被公认为是乙肝病毒复制的活跃期,传染性较强。本文结果显示大三阳组的HBV DNA水平明显高于小三阳组,且差异有统计学意义(P < 0.05),说明大三阳患者乙肝病毒复制水平比小三阳组高,传染性更强。
项目 | 例数(n) | CHI3L1 (ng/mL) | AFP (ng/mL) | ALT (U/L) | AST (U/L) | HBV-DNA (×10n IU/mL) |
---|---|---|---|---|---|---|
小三阳组 | 305 | 49.85 (36.60, 74.33) | 2.50 (1.76, 3.64) | 25.00 (17.75, 41.00) | 26.00 (22.00, 33.00) | 2 (1, 3) |
大三阳组 | 143 | 41.30 (28.98, 62.03) | 2.55 (1.85, 3.56) | 28.00 (21.00, 54.00) | 27.00 (22.00, 38.25) | 5 (1, 7) |
Z | −3.872 | −0.864 | −2.778 | −1.537 | −6.234 | |
P | <0.05 | >0.05 | <0.05 | >0.05 | <0.05 |
表1. 两组患者的乙肝血清学及生化指标比较(M (P25, P75))
项目 | 例数(n) | <50岁 | ||||
---|---|---|---|---|---|---|
CHI3L1 | AFP | ALT | AST | HBV-DNA (×10n IU/mL) | ||
小三阳组 | 204 | 43.85 (33.78, 60.80) | 2.55 (1.81, 3.69) | 26.00 (17.75, 42.00) | 25.00 (21.00, 32.00) | 2 (1, 3) |
大三阳组 | 120 | 38.55 (28.28, 57.73) | 2.55 (1.92, 3.56) | 30.50 (21.00, 54.00) | 27.00 (21.75, 37.25) | 5 (1, 7) |
Z | −2.501 | −0.329 | −2.434 | −1.669 | −6.355 | |
P | <0.05 | >0.05 | <0.05 | >0.05 | <0.05 | |
项目 | 例数(n) | ≥50岁 | ||||
CHI3L1 | AFP | ALT | AST | HBV-DNA (×10n IU/mL) | ||
小三阳组 | 101 | 67.60 (50.03, 123.58) | 2.42 (1.64, 3.42) | 24.00 (17.25, 34.75) | 27.00 (23.00, 37.00) | 2 (1, 3) |
大三阳组 | 23 | 58.50 (38.05, 126.85) | 2.56 (1.84, 4.07) | 26.00 (22.25, 50.00) | 27.50 (23.25, 44.00) | 1 (1, 6.5) |
Z | −1.099 | −0.891 | −1.008 | −0.726 | −0.550 | |
P | >0.05 | >0.05 | >0.05 | >0.05 | >0.05 |
表2. 两组患者各年龄段各项指标比较(M (P25, P75))
项目 | 例数(n) | HBV-DNA (IU/mL) | |||
---|---|---|---|---|---|
<×102 | |||||
CHI3L1 | AFP | ALT | AST | ||
小三阳组 | 94 | 50.50 (36.80, 68.25) | 2.32 (1.72, 3.67) | 25.00 (17.25, 38.75) | 26.00 (23.00, 32.75) |
大三阳组 | 42 | 39.50 (30.80, 54.60) | 2.25 (1.82, 3.19) | 24.00 (17.00, 30.00) | 23.00 (20.00, 29.00) |
Z | −3.053 | −0.306 | −0.936 | −1.642 | |
P | <0.05 | >0.05 | >0.05 | >0.05 | |
项目 | 例数(n) | HBV-DNA (IU/mL) | |||
×102~×103 | |||||
CHI3L1 | AFP | ALT | AST | ||
小三阳组 | 137 | 48.10 (35.40, 74.10) | 2.46 (1.76, 3.21) | 24.00 (16.00, 36.00) | 23.00 (20.00, 30.00) |
大三阳组 | 16 | 55.90 (31.85, 87.35) | 2.96 (2.17, 4.85) | 21.00 (15.50, 37.00) | 23.00 (18.00, 30.50) |
Z | −0.575 | −1.917 | −0.200 | −0.029 | |
P | >0.05 | >0.05 | >0.05 | >0.05 | |
项目 | 例数(n) | HBV-DNA (IU/mL) | |||
×104~×105 | |||||
CHI3L1 | AFP | ALT | AST | ||
小三阳组 | 56 | 54.00 (36.90, 97.30) | 2.72 (2.13, 4.32) | 29.00 (20.00, 51.00) | 29.00 (23.00, 36.00) |
大三阳组 | 27 | 47.60 (28.30, 82.40) | 3.57 (2.14, 7.81) | 44.00 (27.00, 92.00) | 37.00 (24.00, 60.00) |
Z | −1.599 | −1.351 | −2.268 | −1.989 | |
P | >0.05 | >0.05 | <0.05 | <0.05 | |
项目 | 例数(n) | HBV-DNA (IU/mL) | |||
>×105 | |||||
CHI3L1 | AFP | ALT | AST | ||
小三阳组 | 10 | 64.75 (57.43, 102.40) | 3.60 (2.40, 4.43) | 159.00 (35.50, 294.50) | 82.50 (36.00, 176.25) |
大三阳组 | 58 | 39.70 (26.80, 60.80) | 2.22 (1.67, 3.05) | 40.00 (23.00, 59.00) | 28.00 (22.00, 42.00) |
Z | −2.078 | −1.810 | −2.142 | −2.496 | |
P | <0.05 | >0.05 | <0.05 | <0.05 |
表3. 两组不同HBV DNA载量患者的各项指标比较(M (P25, P75))
肝功能指标检测能够反映乙肝患者肝炎活动程度。ALT是肝炎活动程度的一个敏感指标,其水平表达越高表明肝脏的受损程度越严重 [
肝纤维化是肝细胞对诸如病毒感染、毒素、酗酒以及其他慢性损伤的一种修复反应,肝纤维化伴随着由炎症引起的肝实质的破坏和修复的一个持续不断的过程,而且往往会造成严重的并发症 [
在急慢性肝炎、肝硬化等肝病中血清AFP水平有不同程度的升高 [
综上所述,乙肝“大三阳”患者血清中HBV DNA载量以及肝功能损伤程度较“小三阳”患者增高,而小三阳组的CHI3L1水平明显高于大三阳组,另外,两组中AFP均与HBV DNA载量呈正相关。本研究的结果提示乙肝患者应该定期去医院进行监测,有利于提高抗病毒治疗效果,防止肝损伤加重引起肝纤维化及肝癌等严重后果。本研究存在一定的局限性,本文为回顾性研究,难以避免选择性偏倚,其次本文研究样本量不够多,且为单中心研究,结论外推性受限。
潘晓娟,吴胜军. 乙肝“大三阳”和“小三阳”患者血清中HBV DNA载量、肝功能指标、肝纤维化标志物及肝癌标志物比较分析Comparison of HBV DNA Load, Liver Function Index, Liver Fibrosis Markers and Liver Cancer Markers between Hepatitis B Patients with HBsAg, HBeAg, and HBcAb Test Positive and HBsAg, HBeAb, and HBcAb Test Positive[J]. 临床医学进展, 2022, 12(08): 7405-7410. https://doi.org/10.12677/ACM.2022.1281069