中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
15期
6841-6847
,共7页
张占卿%陆伟%王雁冰%周新兰%黄丹%丁荣蓉%沈芳%冯艳玲
張佔卿%陸偉%王雁冰%週新蘭%黃丹%丁榮蓉%瀋芳%馮豔玲
장점경%륙위%왕안빙%주신란%황단%정영용%침방%풍염령
肝炎表面抗原,乙型%肝炎病毒,乙型%肝炎,乙型,慢性%肝硬化%Bayes判别分析%无创诊断
肝炎錶麵抗原,乙型%肝炎病毒,乙型%肝炎,乙型,慢性%肝硬化%Bayes判彆分析%無創診斷
간염표면항원,을형%간염병독,을형%간염,을형,만성%간경화%Bayes판별분석%무창진단
Hepatitis B surface antigen%Hepatitis B virus%Hepatitis B,chronic%Liver Cirrhosis%Bayes discriminant analysis%Non-invasive diagnosis
目的：构建基于血清HBsAg水平、HBV DNA载量、HBsAg/HBV DNA比值判别慢性乙型肝炎肝组织不同病理学分级和分期的Fisher判别函数，评价Fisher判别函数判别肝组织不同病理学分级和分期的效能。方法472例经肝组织活检的慢性乙型肝炎患者入选本研究，其中HBeAg阳性279例，HBeAg阴性193例。血清HBsAg采用Abbott Architect I2000及其配套试剂检测，血清HBV DNA采用实时荧光定量PCR检测。统计分析采用SPSS 13.0软件。结果 HBeAg阳性患者血清HBsAg、HBV DNA与病理学分级和分期呈显著负相关（P＜0.05）；血清HBsAg/HBV DNA与病理学分级呈显著负相关（P＜0.01），与病理学分期无显著相关性（P＞0.05）。HBeAg阴性患者血清HBsAg与病理学分级和分期均无显著相关性（P＞0.05），血清HBV DNA、HBsAg/HBV DNA分别与病理学分级和分期呈显著正相关和负相关（P＜0.01）。根据Bayes 逐步判别分析，HBeAg阳性和阴性患者符合判别不同病理学分级的模型纳入自变量标准的指标分别只有血清HBsAg和HBsAg/HBV DNA，符合判别不同病理学分期的模型纳入自变量标准的指标分别有血清HBsAg、HBV DNA和HBV DNA。判别HBeAg阳性患者不同病理学分级的Fisher判别函数判别G1、G2、G3的一致率分别为5.8%、51.1%、59.1%，判别HBeAg阴性患者不同病理学分级的Fisher判别函数判别G1、G2、G3的一致率分别为95.5%、0.0%、5.7%；判别HBeAg阳性患者不同病理学分期的Fisher判别函数判别S1、S2、S3、S4的一致率分别为36.4%、34.9%、21.6%、57.9%，判别HBeAg阴性患者不同病理学分期的Fisher判别函数判别S1、S2、S3、S4的一致率分别为86.7%、29.4%、0.0%、0.0%。结论基于血清HBsAg和基于血清HBsAg、HBV DNA的Fisher判别函数分别对HBeAg阳性患者肝组织病理学分级G3和分期S4有重要的判别价值；基于HBsAg/HBV DNA比值和基于血清HBV DNA的Fisher判别函数对HBeAg阴性患者肝组织病理学分级G1和分期S1有重要的判别价值。
目的：構建基于血清HBsAg水平、HBV DNA載量、HBsAg/HBV DNA比值判彆慢性乙型肝炎肝組織不同病理學分級和分期的Fisher判彆函數，評價Fisher判彆函數判彆肝組織不同病理學分級和分期的效能。方法472例經肝組織活檢的慢性乙型肝炎患者入選本研究，其中HBeAg暘性279例，HBeAg陰性193例。血清HBsAg採用Abbott Architect I2000及其配套試劑檢測，血清HBV DNA採用實時熒光定量PCR檢測。統計分析採用SPSS 13.0軟件。結果 HBeAg暘性患者血清HBsAg、HBV DNA與病理學分級和分期呈顯著負相關（P＜0.05）；血清HBsAg/HBV DNA與病理學分級呈顯著負相關（P＜0.01），與病理學分期無顯著相關性（P＞0.05）。HBeAg陰性患者血清HBsAg與病理學分級和分期均無顯著相關性（P＞0.05），血清HBV DNA、HBsAg/HBV DNA分彆與病理學分級和分期呈顯著正相關和負相關（P＜0.01）。根據Bayes 逐步判彆分析，HBeAg暘性和陰性患者符閤判彆不同病理學分級的模型納入自變量標準的指標分彆隻有血清HBsAg和HBsAg/HBV DNA，符閤判彆不同病理學分期的模型納入自變量標準的指標分彆有血清HBsAg、HBV DNA和HBV DNA。判彆HBeAg暘性患者不同病理學分級的Fisher判彆函數判彆G1、G2、G3的一緻率分彆為5.8%、51.1%、59.1%，判彆HBeAg陰性患者不同病理學分級的Fisher判彆函數判彆G1、G2、G3的一緻率分彆為95.5%、0.0%、5.7%；判彆HBeAg暘性患者不同病理學分期的Fisher判彆函數判彆S1、S2、S3、S4的一緻率分彆為36.4%、34.9%、21.6%、57.9%，判彆HBeAg陰性患者不同病理學分期的Fisher判彆函數判彆S1、S2、S3、S4的一緻率分彆為86.7%、29.4%、0.0%、0.0%。結論基于血清HBsAg和基于血清HBsAg、HBV DNA的Fisher判彆函數分彆對HBeAg暘性患者肝組織病理學分級G3和分期S4有重要的判彆價值；基于HBsAg/HBV DNA比值和基于血清HBV DNA的Fisher判彆函數對HBeAg陰性患者肝組織病理學分級G1和分期S1有重要的判彆價值。
목적：구건기우혈청HBsAg수평、HBV DNA재량、HBsAg/HBV DNA비치판별만성을형간염간조직불동병이학분급화분기적Fisher판별함수，평개Fisher판별함수판별간조직불동병이학분급화분기적효능。방법472례경간조직활검적만성을형간염환자입선본연구，기중HBeAg양성279례，HBeAg음성193례。혈청HBsAg채용Abbott Architect I2000급기배투시제검측，혈청HBV DNA채용실시형광정량PCR검측。통계분석채용SPSS 13.0연건。결과 HBeAg양성환자혈청HBsAg、HBV DNA여병이학분급화분기정현저부상관（P＜0.05）；혈청HBsAg/HBV DNA여병이학분급정현저부상관（P＜0.01），여병이학분기무현저상관성（P＞0.05）。HBeAg음성환자혈청HBsAg여병이학분급화분기균무현저상관성（P＞0.05），혈청HBV DNA、HBsAg/HBV DNA분별여병이학분급화분기정현저정상관화부상관（P＜0.01）。근거Bayes 축보판별분석，HBeAg양성화음성환자부합판별불동병이학분급적모형납입자변량표준적지표분별지유혈청HBsAg화HBsAg/HBV DNA，부합판별불동병이학분기적모형납입자변량표준적지표분별유혈청HBsAg、HBV DNA화HBV DNA。판별HBeAg양성환자불동병이학분급적Fisher판별함수판별G1、G2、G3적일치솔분별위5.8%、51.1%、59.1%，판별HBeAg음성환자불동병이학분급적Fisher판별함수판별G1、G2、G3적일치솔분별위95.5%、0.0%、5.7%；판별HBeAg양성환자불동병이학분기적Fisher판별함수판별S1、S2、S3、S4적일치솔분별위36.4%、34.9%、21.6%、57.9%，판별HBeAg음성환자불동병이학분기적Fisher판별함수판별S1、S2、S3、S4적일치솔분별위86.7%、29.4%、0.0%、0.0%。결론기우혈청HBsAg화기우혈청HBsAg、HBV DNA적Fisher판별함수분별대HBeAg양성환자간조직병이학분급G3화분기S4유중요적판별개치；기우HBsAg/HBV DNA비치화기우혈청HBV DNA적Fisher판별함수대HBeAg음성환자간조직병이학분급G1화분기S1유중요적판별개치。
Objective To build the Fisher discriminant functions based on serum HBsAg levels, HBV DNA loads and HBsAg/HBV DNA ratios for discrimination of different pathological grading and staging of liver tissues in patients with hepatitis B, and to appraise the efficacy of the Fisher discriminant functions for discrimination of different pathological grading and staging of liver tissues. Methods 472 consecutive patients with chronic hepatitis B with pathological diagnoses of liver tissues, including 279 HBeAg-positive and 193 HBeAg-negative patients, were enrolled in present study. Serum HBsAg and HBeAg were determined by Abbott Architect I2000 and auxiliary reagents, serum HBV DNA was determined by real-time fluorescence quantitative PCR. SPSS 13. 0 software was used for statistical analyses.Results In HBeAg-positive patients, serum HBsAg level and HBV DNA load were negatively correlated significantly with pathological grading and staging(P<0.05), serum HBsAg/HBV DNA ratio was negatively correlated significantly with pathological grading(P<0.01) and not correlated significantly with pathological staging(P>0.05). In HBeAg-negative patients, serum HBsAg level was not correlated significantly with pathological grading and staging(P>0.05), serum HBV DNA load was positively and HBsAg/HBV DNA ratio was negatively correlated significantly with pathological grading and staging(P<0.01). According to the Bayes stepwise discriminant analyses, only serum HBsAg in HBeAg-positive patients and only serum HBsAg/HBV DNA ratio in HBeAg-negative patients conformed to the entry criteria of the independents of the models for discrimination of different pathological grading, and serum HBsAg and HBsAg/HBV DNA ratio in HBeAg-positive patients and only serum HBV DNA in HBeAg-negative patients conformed to the entry criteria of the independents of the models for discrimination of different pathological staging. The correctly classified rates of the original grouped cases by the Fisher discriminant functions for discrimination of different pathological grading in HBeAg-positive patients were 5.8% for G1, 51.1% for G2, 59.1%for G3, respectively;and those in HBeAg-negative patients were 95.5%for G1, 0.0%for G2, 5.7%for G3, respectively. The correctly classified rates of the original grouped cases by the Fisher discriminant functions for discrimination of different pathological staging in HBeAg-positive patients were 36.4% for S1, 34.9% for S2, 21.6%for S3, 57.9%for S4, respectively;and those in HBeAg-negative patients were 86.7%for S1, 29.4%for S2, 0.0%for S3, 0.0%for S4, respectively. Conclusions The Fisher discriminant functions based on serum HBsAg levels and those based on serum HBsAg levels and HBV DNA loads have discriminant significance for pathological grading G3 and staging S4 respectively in HBeAg-positive patients;the Fisher discriminant functions based on serum HBsAg/HBV DNA ratios and those based on serum HBV DNA loads have discriminant significance for pathological grading G1 and staging S1 respectively in HBeAg-negative patients.
