[1]杨 阳,张欢妍,吕 幸,等.筛选血清HBV-DNA 阴性且HBsAg 与HBsAb 阳性CHB 患者的血清危险因素及评分与预后的相关性研究[J].现代检验医学杂志,2023,38(06):153-158.[doi:10.3969/j.issn.1671-7414.2023.06.028]
　YANG Yang,ZHANG Huanyan,L? Xing,et al.Correlation of Screening for Serum Risk Factors and Risk Factor Score to Prognosis between DNA-negative and Co-existing with HBsAg/HBsAb in CHB Patients[J].Journal of Modern Laboratory Medicine,2023,38(06):153-158.[doi:10.3969/j.issn.1671-7414.2023.06.028]
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筛选血清HBV-DNA 阴性且HBsAg 与HBsAb 阳性CHB 患者的血清危险因素及评分与预后的相关性研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年06期
页码:
153-158
栏目:
检验与临床
出版日期:
2023-11-15

文章信息/Info

Title:
Correlation of Screening for Serum Risk Factors and Risk Factor Score to Prognosis between DNA-negative and Co-existing with HBsAg/HBsAb in CHB Patients
文章编号:
1671-7414（2023）06-153-06
作者:
杨 阳1; 2; 张欢妍2; 吕 幸2; 彭俊华2
（1.江苏医药职业学院金坛临床学院，江苏常州 213200；2. 江苏大学附属金坛第一人民医院检验科，江苏常州 213200）
Author(s):
YANG Yang1; 2; ZHANG Huanyan2; L? Xing2; PENG Junhua2
（1.Jintan Hospital, the Affiliated Hospital of Jiangsu Vocational College of Medicine, Jiangsu Changzhou 213200, China; 2.Department of Clinical Laboratory, the First People’s Hospital of Jintan Affiliated to Jiangsu University，Jiangsu Changzhou 213200, China）
关键词:
慢性乙型肝炎; 乙肝表面抗原; 乙肝表面抗体; 评分模型
分类号:
R512.62；R446.6
DOI:
10.3969/j.issn.1671-7414.2023.06.028
文献标志码:
A
摘要:
目的 筛选乙肝病毒（hepatitis B virus，HBV）DNA 阴性的乙肝表面抗原（hepatitis B surface antigen，HBsAg）和乙肝表面抗体（hepatitis B surface antibody，HBsAb）阳性的慢性乙型肝炎（chronic hepatitis B，CHB）患者的血清危险因素，探讨危险因素评分与预后的相关性。方法 筛选2020 年１月～ 2022 年6 月江苏大学附属金坛第一人民医院收治的HBV-DNA 阴性的CHB 患者193 例，其中HBsAg 和HBsAb 阳性的119 例患者作为观察组，HBsAg阳性且HBsAb 阴性的74 例患者作为对照组。收集所有患者的临床资料并计算外周血炎性指标[ 嗜中性粒细胞/ 淋巴细胞比值(neutrophil to lymphocyte ratio， NLR)，血小板- 淋巴细胞比值(platelet-to-lymphoccyte ratio，PLR)，全身免疫炎症指数(systemic immune inflammatory index，SII)] 和肝纤维化指标[ 谷氨酰转肽酶- 血小板比值(gamma-glutamyltranspeptidase to platelet ratio，GPR)， 门冬氨酸转移酶纤维化指数(aspartate aminotransferase to platelet ratio index，APRI)，肝纤维化 4 因子指数(fibrosis 4 score，FIB-4)]，采用t 检验和U 检验比较两组间各指标的差异。采用ROC 曲线评价差异指标的预测价值，多因素回归分析影响HBsAg 和HBsAb 阳性模式的危险因素。随访观察组患者二年内HBsAg和HBsAb 变化，将20 例HBsAg 水平明显降低的患者作为预后良好组，24 例HBsAg 水平没有明显降低甚至HBsAb 消失的患者作为预后不良组。结果 与对照组相比，观察组的PLT 水平[（181.07±63.31）×109/L vs （158.27±61.55）×109/L] 和TP 水平[70.20（65.73，74.90）g/L vs 67.00（64.45，71.25）g/L] 明显升高，差异有统计学意义（t=2.459，U=3 254.00，均P ＜ 0.05）；而观察组的HBsAg 水平[1.60（0.37，13.15）IU/ml vs 138.78（8.66，161.94）IU/ml] 和APRI 比值[0.31（0.22，0.47） vs 0.46（0.32，0.71）] 明显降低，差异有统计学意义（U=1 685.50，2 972.00，均P＜ 0.05）。ROC 曲线确定 PLT，TP，APRI 和HBsAg 在两组间的差异的截断值分别为157.50 ×109/L，69.45 g/L，0.29和22.56 IU/ml。单因素回归分析结果显示，PLT ≥ 157.50 ×109/L，TP ≥ 69.45 g/L，APRI ≤ 0.29，HBsAg ≤ 22.56IU/ml 与CHB 患者的HBsAg 和HBsAb 阳性模式相关（χ2=8.231 ～ 50.862，均P ＜ 0.05）；多因素回归分析显示，HBsAg ≤ 22.56 IU/ml [OR（95%CI）：9.853（4.722 ～ 20.560）] 和TP ≥ 69.45 g/L [OR（95%CI）：2.358（1.132 ～ 4.912）]是HBsAg 和HBsAb 阳性模式的独立危险因素（均P ＜ 0.05）。基于上述危险因素建立的评分模型预测HBsAg 和HBsAb阳性模式发生的ROC 曲线下面积（area under curve，AUC）为0.703，灵敏度和特异度分别为66.7% 和73.9%。随访结果显示，预后良好组主要分布在评分模型的高分段（2 分），而预后不良组主要分布在评分模型的低分段（0 分和1 分），差异有统计学意义（χ2=13.838，P =0.001）。结论 HBsAg ≤ 22.56 IU/ml 和TP ≥ 69.45 g/L 是影响HBV-DNA 阴性且HBsAg 与HBsAb 阳性的CHB 患者的独立危险因素，据此建立的评分模型对上述患者的预后有一定的预测价值。
Abstract:
Objective To screen the serum risk factors for chronic hepatitis B (CHB) patients with hepatitis B virus (HBV) DNA negative and hepatitis B surface antigen (HBsAg)/ hepatitis B surface antibody (HBsAb) co-existing, and explore the correlation between risk factors score and prognosis. Methods 119 patients with HBsAg/HBsAb positive in the First People’s Hospital of Jintan Affiliated to Jiangsu University from January 2020 to June 2022 were selected as the observation group, and 74 patients with HBsAg positive and HBsAb negative were selected as the control group. Clinical data of all patients were collected and peripheral blood inflammatory indicators [ neutrophil to lymphocyte ratio(NLR), platelet-to-lymphoccyte ratio(PLR), systemic immune inflammatory index(SII)] and liver fibrosis indicators[gamma-glutamyl transpeptidase to platelet ratio (GPR), aspartate aminotransferase to platelet ratio index(APRI), fibrosis 4 score(FIB-4)] were calculated. t-test and U-test were used to compare the differences between the two groups. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of difference indicators. Risk factors affecting HBsAg and HBsAb positive pattern were analyzed using multivariate regression. Based on changes in HBsAg and HBsAb levels of observation group over 2 years, 20 patients were classified as having a good prognosis with a significant reduction in HBsAg levels and 24 patients as having a poor prognosis without significant reduction in HBsAg levels or even undetectable HBsAb levels. Results Compared with the control group, the levels of PLT [(181.07± 63.31)×109/L vs (158.27 ± 61.55) ×109/L] and TP [70.20(65.73 ～ 74.90) g/L vs 67.00(64.45 ～ 71.25) g/L] in the observation group were increased, the differences were statistically significant (t=2.459, U=3 254.00, all P ＜ 0.05). The levels of HBsAg [1.60(0.37 ～ 13.15) IU/ml vs 138.78(8.66 ～ 161.94) IU/ml] and APRI [0.31(0.22 ～ 0.47) vs 0.46(0.32 ～ 0.71)] in the observation group were decreased, and the differences were statistically significant(U=1 685.50, 2 972.00, all P ＜ 0.05). According to ROC curve, cutoff values of PLT, TP, APRI and HBsAg were 157.50 ×109/L, 69.45 g/L, 0.29 and 22.56 IU/ml, respectively. According to univariate Logistic regression analysis, PLT≥ 157.50×109/L, TP ≥ 69.45 g/L, APRI ≤ 0.29 and HBsAg ≤ 22.56 IU/ml were associated with HBsAg and HBsAb positive pattern (χ2=8.231 ～ 50.862, all P ＜ 0.05). Multivariate Logistic regression analysis revealed that HBsAg≤ 22.56 IU/ml [OR(95%CI): 9.853(4.722～ 20.560)] and TP≥ 69.45 g/L [OR(95%CI): 2.358 (1.132 ～ 4.912)] were independent risk factors for HBsAg and HBsAb positive patterns (all P ＜ 0.05).The ROC curve showed that the area under the curve (AUC) of scoring model established of independent risk factors was 0.703, with a sensitivity of 66.7% and a specificity of 73.9%，respective. The follow-up results showed that HBsAg and HBsAb positive patients with good prognosis had high scores (2 points), while those with poor prognosis had low scores (0 and 1 point) from scoring model, this difference was statistically significant (χ2=13.838, P =0.001). Conclusion HBsAg ≤ 22.56 IU/ml and TP ≥ 69.45 g/L are independent risk factors affect CHB patients with DNA-negative and HBsAg/HBsAb positive, and the scoring model established of these risk factors has certain predictive value for the prognosis of HBsAg/HBsAb positive patients.

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备注/Memo

备注/Memo:
基金项目： 江苏医药职业学院临床教学基地科研发展专项课题（编号：20229135）：基于pgRNA 为指标的HBsAg 阳性肿瘤患者肝损害的研究；常州市科技支撑（社会发展）计划（编号：CE20185004）：参芩白术散调节2 型糖尿病肠道菌群，降低胰岛素抵抗的临床研究及机理探讨。
作者简介：杨阳（1986-），女，硕士，主管检验技师，研究方向：临床免疫学，E-mail：vipyyang@126.com。
通讯作者：彭俊华（1966-），男，博士，主任医师，研究方向：临床检验诊断学，E-mail：junhua_p@126.com。
更新日期/Last Update: 2023-11-15