中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2012年
10期
746-750
,共5页
曾达武%董菁%陈丽红%朱月永%陈靖%郑琦%刘豫瑞%江家骥
曾達武%董菁%陳麗紅%硃月永%陳靖%鄭琦%劉豫瑞%江傢驥
증체무%동정%진려홍%주월영%진정%정기%류예서%강가기
肝炎病毒,乙型%肝炎表面抗原,乙型%肝硬化%炎症%免疫清除期%诊断模型
肝炎病毒,乙型%肝炎錶麵抗原,乙型%肝硬化%炎癥%免疫清除期%診斷模型
간염병독,을형%간염표면항원,을형%간경화%염증%면역청제기%진단모형
Hepatitis B Virus%Hepatitis B surface antigens%Liver cirrhosis%Inflammation%Immune clearance phase%Models,diagnosis
目的 探讨处于免疫清除期(IC)的慢性乙型肝炎(CHB)患者血清HBsAg水平与肝组织炎症分级和纤维化分期的关系.方法 2009年3月至2011年6月确诊为IC期的CHB患者,同步进行肝组织病理学检查、血清HBsAg定量及生物化学指标检测.Spearman等级相关分析法判断HBsAg水平与肝组织炎症分级和纤维化分期之间的相关性；logistic回归分析法分析相关指标的诊断意义,并构建肝脏纤维化诊断预测模型,受试者工作曲线(ROC)法评价模型的诊断价值.结果 共165例IC期CHB患者纳入本研究.炎症G1、G2、G3、G4级患者的血清HBsAg水平分别为(27716.07±32870.69) IU/ml、(34478.75±40899.55)IU/ml、(19408.09±24881.07) IU/ml、(14286.31±28610.14) IU/ml,G2、G3、G4级患者间HBsAg水平差别有统计学意义(x2=10.508,P＜0.05);纤维化S1、S2、S3、S4期的血清HBsAg水平分别(41337.23±43236.39) IU/ml、(27264.32±32517.29) IU/ml、(11541.77±11538.93) IU/ml、(11447.37±22215.44) IU/ml,不同纤维化分期患者的HBsAg水平差异有统计学意义(x2=22.005,P＜0.01).Spearman等级相关分析结果显示,HBsAg水平与炎症分级及纤维化分期均呈负相关关系(r值分别为-0.244和-0.365,P值均＜0.01).HBsAg≤32995 IU/ml判断纤维化S≥4的特异度为95.16％,灵敏度35.92％.二元logistic回归分析结果显示,年龄、白蛋白、胆碱酯酶和HBsAg水平的组合模型有助于判断S≥4,建立诊断模型:S=6.3087+0.0492 ×年龄(岁)-0.5827×HBsAg (log10IU/ml)-0.1109×白蛋白(g/L)-0.0003×胆碱酯酶(IU/L),其灵敏度为75.73％,特异度为69.35％.结论 IC期CHB患者的血清HBsAg水平与肝脏炎症分级和纤维化分期呈负相关关系,且随病理分级的增加而呈阶梯状降低.HBsAg水平可作为无创性判断肝脏纤维化状态的一项重要指标.
目的 探討處于免疫清除期(IC)的慢性乙型肝炎(CHB)患者血清HBsAg水平與肝組織炎癥分級和纖維化分期的關繫.方法 2009年3月至2011年6月確診為IC期的CHB患者,同步進行肝組織病理學檢查、血清HBsAg定量及生物化學指標檢測.Spearman等級相關分析法判斷HBsAg水平與肝組織炎癥分級和纖維化分期之間的相關性；logistic迴歸分析法分析相關指標的診斷意義,併構建肝髒纖維化診斷預測模型,受試者工作麯線(ROC)法評價模型的診斷價值.結果 共165例IC期CHB患者納入本研究.炎癥G1、G2、G3、G4級患者的血清HBsAg水平分彆為(27716.07±32870.69) IU/ml、(34478.75±40899.55)IU/ml、(19408.09±24881.07) IU/ml、(14286.31±28610.14) IU/ml,G2、G3、G4級患者間HBsAg水平差彆有統計學意義(x2=10.508,P＜0.05);纖維化S1、S2、S3、S4期的血清HBsAg水平分彆(41337.23±43236.39) IU/ml、(27264.32±32517.29) IU/ml、(11541.77±11538.93) IU/ml、(11447.37±22215.44) IU/ml,不同纖維化分期患者的HBsAg水平差異有統計學意義(x2=22.005,P＜0.01).Spearman等級相關分析結果顯示,HBsAg水平與炎癥分級及纖維化分期均呈負相關關繫(r值分彆為-0.244和-0.365,P值均＜0.01).HBsAg≤32995 IU/ml判斷纖維化S≥4的特異度為95.16％,靈敏度35.92％.二元logistic迴歸分析結果顯示,年齡、白蛋白、膽堿酯酶和HBsAg水平的組閤模型有助于判斷S≥4,建立診斷模型:S=6.3087+0.0492 ×年齡(歲)-0.5827×HBsAg (log10IU/ml)-0.1109×白蛋白(g/L)-0.0003×膽堿酯酶(IU/L),其靈敏度為75.73％,特異度為69.35％.結論 IC期CHB患者的血清HBsAg水平與肝髒炎癥分級和纖維化分期呈負相關關繫,且隨病理分級的增加而呈階梯狀降低.HBsAg水平可作為無創性判斷肝髒纖維化狀態的一項重要指標.
목적 탐토처우면역청제기(IC)적만성을형간염(CHB)환자혈청HBsAg수평여간조직염증분급화섬유화분기적관계.방법 2009년3월지2011년6월학진위IC기적CHB환자,동보진행간조직병이학검사、혈청HBsAg정량급생물화학지표검측.Spearman등급상관분석법판단HBsAg수평여간조직염증분급화섬유화분기지간적상관성；logistic회귀분석법분석상관지표적진단의의,병구건간장섬유화진단예측모형,수시자공작곡선(ROC)법평개모형적진단개치.결과 공165례IC기CHB환자납입본연구.염증G1、G2、G3、G4급환자적혈청HBsAg수평분별위(27716.07±32870.69) IU/ml、(34478.75±40899.55)IU/ml、(19408.09±24881.07) IU/ml、(14286.31±28610.14) IU/ml,G2、G3、G4급환자간HBsAg수평차별유통계학의의(x2=10.508,P＜0.05);섬유화S1、S2、S3、S4기적혈청HBsAg수평분별(41337.23±43236.39) IU/ml、(27264.32±32517.29) IU/ml、(11541.77±11538.93) IU/ml、(11447.37±22215.44) IU/ml,불동섬유화분기환자적HBsAg수평차이유통계학의의(x2=22.005,P＜0.01).Spearman등급상관분석결과현시,HBsAg수평여염증분급급섬유화분기균정부상관관계(r치분별위-0.244화-0.365,P치균＜0.01).HBsAg≤32995 IU/ml판단섬유화S≥4적특이도위95.16％,령민도35.92％.이원logistic회귀분석결과현시,년령、백단백、담감지매화HBsAg수평적조합모형유조우판단S≥4,건립진단모형:S=6.3087+0.0492 ×년령(세)-0.5827×HBsAg (log10IU/ml)-0.1109×백단백(g/L)-0.0003×담감지매(IU/L),기령민도위75.73％,특이도위69.35％.결론 IC기CHB환자적혈청HBsAg수평여간장염증분급화섬유화분기정부상관관계,차수병리분급적증가이정계제상강저.HBsAg수평가작위무창성판단간장섬유화상태적일항중요지표.
Objective To investigate whether the level of hepatitis B surface antigen (HBsAg)represents the status of inflammation and stages of fibrosis in livers of patients with chronic hepatitis B (CHB) during the immune clearance phase (IC).Methods Liver biopsy samples and sera were collected from 165 consecutive patients (136 males; 29 females) with CHB in IC who were treated in our hospital between March 2009 and June 2011.Routine biochemical tests were carried out to measure indicators of liver function.The relation between HBsAg level and liver pathological stages were determined by Spearman's rank correlation analysis.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of HBsAg level for liver pathological stages.Binary logistic regression was used to analyze potentially relevant indicators,and liver pathology-predicting models were built and analyzed by the ROC method.Results The mean values of HBsAg (IU/mL) were significantly different at the different liver inflammation stages:GI,27716.07 ± 32870.69; G2,34478.75 ± 40899.55; G3,19408.09 ± 24881.07; G4,14286.31 ± 28610.14.Likewise,the mean values of HBsAg (IU/mL) were significantly different at the different liver fibrosis stages:S1,41337.23 ± 43236.39; S2,27264.32 ± 32517.29; S3,111541.77 ± 11538.93; S4,11447.37 ±22215.44.Spearman's rank correlation analysis indicated a significant correlation between HBsAg level and liver inflammation stage (rs=-0.244) and fibrosis stage (rs=-0.365).ROC curve analysis of the diagnostic value of HBsAg for inflammation stages S ≥ 4 revealed that the area under the curve (AUC) was 0.70.The specificity of diagnosing S ≥ 4 was ＞ 95.16％ when HBsAg was ≤ 32995 IU/mL.Binary logistic regression analysis identified age,serum albumin,cholinesterase,and HBsAg as independent predictors of liver fibrosis.Conclusion HBsAg level is negatively correlated with liver inflammation and fibrosis stages for patients with CHB in the IC phase,and might represent a useful noninvasive marker of the degree of hepatic fibrosis.
