HBsAg定量检测对慢性重型乙型肝炎患者预后的预测价值

高娜; 吴瑞红; 王晓美; 牛俊奇

doi:10.3969/j.issn.1001-5256.2016.04.017

HBsAg定量检测对慢性重型乙型肝炎患者预后的预测价值

DOI: 10.3969/j.issn.1001-5256.2016.04.017

1. 新疆医科大学第一附属医院
2. 吉林大学第一医院肝病科

基金项目:

国家十二五科技重大专项(2013ZX10002008)；十二五传染病重大专项(2014ZX10002002)；

详细信息

中图分类号: R512.62
计量
- 文章访问数: 2584
- HTML全文浏览量: 21
- PDF下载量: 441
- 被引次数: 0
出版历程
- 出版日期: 2016-04-20

Value of HBsAg quantification in predicting the prognosis of patients with chronic severe hepatitis B

The First Hospital Affiliated to Xinjiang Medical University

Research funding:

摘要

摘要:
目的探索HBs Ag定量对慢性重型乙型肝炎患者预后的预测价值。方法回顾性分析2012年1月-2015年8月吉林大学第一医院收治的慢性HBV感染的重型肝炎患者61例,并随访患者90 d。患者血清HBs Ag水平通过微粒子发光法检测。受试者工作特征曲线用于选取HBs Ag的临界值,据此将患者分为4组:HBs Ag<1.63 1.63="" ml2.61="" 2.61="" ml3.62="" hbs="" ag="">3.62 log10IU/ml组。计量资料多组间比较采用Kruskal-Wallis检验,2组间比较采用Mann-Whitney U检验。计数资料组间比较采用Fisher精确检验。多组间生存曲线比较采用log-rank检验。Cox单因素和多因素回归用于分析与慢性重型乙型肝炎预后相关的因素,获得每个变量的风险比（HR）。相关性比较采用Spearman相关分析。结果4组患者的生存时间差异有统计学意义（χ2=18....
- 肝炎,乙型,慢性 /
- 肝炎表面抗原,乙型 /
- 预后 /
- 危险因素
Abstract:
Objective To investigate the value of HBs Ag quantification in predicting the prognosis of patients with chronic severe hepatitis B. Methods The clinical data of 61 patients with chronic severe hepatitis B who were admitted to The First Hospital of Jilin University from January 2012 to August 2015 were analyzed retrospectively and were followed up for 90 days. Chemiluminescent microparticle immunoassay was used to measure the serum HBs Ag level. The receiver operating characteristic curves were used to determine the cut- off value of HBs Ag,and according to this value,the patients were divided into HBs Ag < 1. 63 log10 IU / ml group,1. 63- 2. 61 log10 IU / ml group,2. 61-3. 62 log10 IU / ml group,and HBs Ag > 3. 62 log10 IU / ml group. The Kruskal- Wallis test was used for comparison of continuous data between multiple groups,the Mann- Whitney U test was used for comparison of continuous data between two groups,and the Fisher' s exact test was used for comparison of categorical data between groups. The log- rank test was used for comparison of survival curves between multiple groups. The univariate and multivariate Cox regression analyses were used to analyze the factors related to the prognosis of chronic severe hepatitis B and obtain the hazards ratio( HR) of each variable. The Spearman correlation analysis was used for correlation analysis. Results The survival time showed a significant difference between the four groups( χ~2= 18. 261,P < 0. 001). The HBs Ag < 1. 63 log10 IU / ml group had a significantly lower 90- day survival rate than the 2. 61- 3. 62 log10 IU / ml group( χ~2= 10. 283,P = 0. 001) and the HBs Ag >3. 62 log10 IU / ml group( χ~2= 17. 236,P < 0. 001). The multivariate Cox regression analysis showed that HBs Ag( HR = 0. 562,95% CI:0. 364- 0. 870,P = 0. 010),blood urea nitrogen( HR = 1. 111,95% CI: 1. 042- 1. 185,P = 0. 001),hepatic encephalopathy( HR =4. 123,95% CI: 1. 729- 9. 830,P = 0. 001),and Model for End- Stage Liver Disease( MELD) score( HR = 1. 093,95% CI: 1. 024~(-1). 166,P = 0. 007) were independent risk factors for the 90- day survival rate of patients with chronic severe hepatitis B. HBs Ag showed a low correlation with HBV DNA( r = 0. 326,P = 0. 01). Conclusion Serum HBs Ag level is an important factor in predicting the prognosis of patients with chronic severe hepatitis B.
- hepatitis B,chronic /
- hepatitis B surface antigens /
- prognosis /
- risk factors

HTML全文

参考文献(12)

[1]ZHAN GQ,ZHENG SJ,ZHU L,et al.The clinical analysis on factor influencing the prognosis of severe hepatitis in 365 cases[J].J Clin Hepatol,2008,24(4):251-253.(in Chinese)占国清,郑三菊,朱琳,等.365例重型肝炎预后影响因素的临床分析[J].临床肝胆病杂志,2008,24(4):251-253.

[2]Chinese Society of Infectious Diseases and Parasitology,Chinese Society of Hepatology,Chinese Medical Association.Prevention and treatment of viral hepatitis[J].Chin J Infect Dis,2001,19(1):56-62.(in Chinese)中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):56-62.

[3]MANESIS EK,HADZIYANNIS ES,ANGELOPOULOU OP,et al.Prediction of treatment-related HBsA g loss in HBeA g-negative chronic hepatitis B:a clue from serum HBsA g levels[J].Antivir T-her,2007,12(1):73-82.

[4]BRUNETTO MR,MORICONI F,BONINO F,et al.Hepatitis Bvirus surface antigen levels:a guide to sustained response to peginterferon alfa-2a in HBeA g-negative chronic hepatitis B[J].Hepatology,2009,49(4):1141-1150.

[5]TSENG TC,KAO JH.Clinical utility of quantitative HBsA g in natural history and nucleos(t)ide analogue treatment of chronic hepatitis B:new trick of old dog[J].Gastroenterol,2013,48(1):13-21.

[6]LARSSON SB,EILARD A,MALMSTROM S,et al.HBsA g quantification for identification of liver disease in chronic hepatitis B virus carriers[J].Liver Int,2014,34(7):e238-e245.

[7]HONG MZ,HUANG WQ,MIN F,et al.Enhanced HBsA g synthesis correlates with increased severity of fibrosis in chronic hepatitis Bpatients[J].PLoS One,2014,9(1):e87344.

[8]GUPTA E,KUMAR A,CHOUDHARY A,et al.Serum hepatitis Bsurface antigen levels correlate with high serum HBV DNA levels in patients with chronic hepatitis B:a cross-sectional study[J].Indian J Med Microbiol,2012,30(2):150-154.

[9]ZHOU HB,LI JY,ZHAO YH,et al.Quantitation of hepatitis Bsurface antigen(HBsA g)in the natural course of hepatitis B virus(HBV)-infection[J].J Harbin Med Univ,2013,47(4):350-352.(in Chinese)周洪波,李晶媛,赵勇华,等.乙型肝炎病毒感染不同阶段HBsA g定量变化的研究[J].哈尔滨医科大学学报,2013,47(4):350-352.

[10]LAI J,SUN HX,JIE YS,et al.Serum HBsA g level and its clinical significance in lamivudine treatment for patients with HBeA g-negative acute-on-chronic liver failure[J].Int J Infect Dis,2014,22:78-82.

[11]ALTINBAS A,YUKSEL I,PAMUKCU M,et al.Spontaneous HB-sA g seroconversion after severe flare of chronic hepatitis B infection[J].Ann Hepatol,2010,9(2):194-197.

[12]DONG AA,ZHAO J,JIA JW,et al.Role of HBsA g quantitative detection in evaluation of liver reserve function in patients with chronic HBV infection[J].World Chin J Dig,2012,20(31):3033-3036.(in Chinese)董爱爱,赵洁,贾建伟,等.HBsA g定量检测在慢性HBV感染患者肝脏储备功能评价中的作用[J].世界华人消化杂志,2012,20(31):3033-3036.

施引文献

资源附件(0)

访问统计