【摘要】：目的:1.探討IC期肝組織HBV標志物與血清HBV標志物之間的相關(guān)性。2.探討肝組織HBV標志物在預(yù)測聚乙二醇干擾素α-2a治療HBeAg陽性慢性乙型肝炎HBeAg血清學(xué)轉(zhuǎn)換中的作用。 方法:回顧性分析2008年1月~2012年1月確診為IC期的CHB患者，同步收集并分析肝臟組織學(xué)及血清學(xué)資料， S-P法檢測肝細胞中HBsAg、HBcAg表達，采用Spearman等級相關(guān)分析探討肝組織HBsAg、HBcAg表達與血清.HBsAg水平之間的相關(guān)性；部分IC期CHB患者給予PEG-IFNα-2a180μg治療48周，停藥后隨訪24周，，其中發(fā)生HBeAg血清學(xué)轉(zhuǎn)換的為應(yīng)答組，未發(fā)生HBeAg血清學(xué)轉(zhuǎn)換的為無應(yīng)答組。采用多因素回歸法探討肝組織HBsAg表達對HBeAg血清學(xué)轉(zhuǎn)換的預(yù)測價值，P0.05表示差異有統(tǒng)計學(xué)意義。 結(jié)果:1.根據(jù)納入排除標準，共有245例IC期CHB患者納入本研究。相關(guān)性分析提示：肝組織HBsAg表達與血清HBeAg、HBsAg、HBVDNA正相關(guān)（r=0.187，P=0.003; r=0.401，P=0.000; r=0.339，P=0.000），而與年齡、ALT、AST、炎癥分級及纖維化分期無關(guān)；肝組織HBcAg表達與血清HBeAg、HBsAg、HBVDNA正相關(guān)（r=0.213，P=0.001； r=0.302，P=0.000；r=0.323，P=0.000），與纖維化分期負相關(guān)（r=-0.137，P=0.035），而與年齡、ALT、AST、炎癥分級無關(guān)。 2.根據(jù)納入與排除標準，本研究共入組患者71例，應(yīng)答組28例，無應(yīng)答組43例。48周療程結(jié)束后隨訪24周，ALT復(fù)常率為81.7%（57/71），HBV DNA陰轉(zhuǎn)率為77.5%（55/71），HBeAg血清轉(zhuǎn)換率為39.4%（28/71），HBsAg消失率為7%（5/71），其中有1例（1.4%）實現(xiàn)HBsAg血清學(xué)轉(zhuǎn)換。單因素分析結(jié)果顯示，血清學(xué)轉(zhuǎn)換組患者（應(yīng)答組）肝臟組織HBsAg染色膜表達強度較未轉(zhuǎn)換者（無應(yīng)答組）低（Z值=-2.0，P=0.045），血清HBsAg定量較無應(yīng)答組低（3.84±0.95VS4.27±0.61，P=0.029）；應(yīng)答組與無應(yīng)答組的性別、年齡、組織炎癥及纖維化程度、ALT、HBeAg半定量、HBV DNA、肝內(nèi)HBsAg、HBcAg水平等指標與HBeAg血清學(xué)轉(zhuǎn)換無顯著關(guān)系。經(jīng)過二元logistic回歸分析結(jié)果提示，組織學(xué)HBsAg膜表達仍是HBeAg血清學(xué)轉(zhuǎn)換的獨立預(yù)測因素（OR=3.1295%CI=1.062-9.158P=0.039）。 結(jié)論:1.IC期CHB患者血清HBsAg濃度可反映肝內(nèi)HBsAg表達強度；2.肝組織HBsAg膜表達較血清HBsAg更有助于預(yù)測PEG-IFNα-2a治療HBeAg陽性CHB患者的HBeAg血清學(xué)應(yīng)答。
[Abstract]:Purpose 1. To investigate the correlation between HBV markers in liver tissue and serum HBV markers in IC phase. 2. 2. To investigate the role of liver tissue HBV markers in predicting the serological transition of HBeAg positive chronic hepatitis B (HBeAg) with pegylated interferon 偽 -2a (peginterferon 偽 -2a). Methods: the liver histological and serological data were collected and analyzed from January 2008 to January 2012 in CHB patients diagnosed as IC. S-P method was used to detect the expression of HBsAg,HBcAg in hepatocytes. Spearman grade correlation analysis was used to investigate the correlation between the expression of HBsAg,HBcAg in liver tissue and the level of serum. Some CHB patients in IC stage were treated with PEG-IFN 偽 -2a180 渭 g for 48 weeks, followed up for 24 weeks after withdrawal. No HBeAg serological conversion was found in the non-responsive group. Multivariate regression method was used to study the predictive value of HBsAg expression in liver tissue for serological transformation of HBeAg. The result is 1: 1. According to exclusion criteria, a total of 245 patients with IC stage CHB were included in this study. The correlation analysis indicated that the expression of HBsAg in liver tissue was positively correlated with serum HBeAg,HBsAg,HBVDNA (r = 0.187, P ~ (0.003); r = 0.401, P ~ (0.000); ~ (0.339) P ~ (0.000), P ~ (0.000), but not with age, grade of inflammation and stage of fibrosis, the expression of HBcAg in liver tissue was positively correlated with serum HBeAg,HBsAg,HBVDNA (r _ (0.213) P _ (0.001), r ~ (0.302) P ~ + P ~ (0.000), P ~ (0.000), P ~ (0.000), P ~ (0.000). There was a negative correlation with the stage of fibrosis (r = -0.137, P 0.035), but no correlation with the age of ALT and inflammation grade. 2. According to the inclusion and exclusion criteria, there were 71 patients in the study group and 28 patients in the response group. In the non-response group, 43 cases were followed up for 24 weeks after the end of the course of treatment for 24 weeks. The seroconversion rate of HBV DNA was 77.5% (55 / 71). The seroconversion rate of HBeAg was 39.4% (28 / 71), and the disappearance rate of HBeAg was 7% (5 / 71). Among them, 1 case (1.4%) achieved serological conversion of HBsAg. The results of univariate analysis showed that the expression intensity of HBsAg in liver tissue of patients with seroconversion was lower than that of non-responders (Z = -2.0), and the serum HBsAg was lower than that of non-responders (3.84 鹵0.95VS4.27 鹵0.61), and the sex of responders and non-responders was lower than that of non-responders. Age, tissue inflammation and degree of fibrosis were not significantly correlated with HBeAg serological transformation in patients with ALT HBeAg semi-quantitative HBV-HBV-HBV-HBV-HBeAg intrahepatic HBsAg,HBcAg level. The results of binary logistic regression analysis showed that the expression of histological HBsAg membrane was still an independent predictor of HBeAg serological transformation (OR=3.1295%CI=1.062-9.158P=0.039). Conclusion 1. The concentration of serum HBsAg in CHB patients at IC stage can reflect the expression intensity of HBsAg in liver. The expression of HBsAg in liver tissue was more helpful than serum HBsAg in predicting the HBeAg serological response of HBeAg 偽 -2a patients with HBeAg positive CHB.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62

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相關(guān)期刊論文 前1條

1 楊玖玲;鄭芳;;兩例罕見乙肝HBsAg突變檢測報告分析[J];中國免疫學(xué)雜志;2008年04期

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