乙肝“大三阳”和“小三阳”患者血清中HBV DNA载量、肝功能指标、肝纤维化标志物及肝癌标志物比较分析

Comparison of HBV DNA Load, Liver Function Index, Liver Fibrosis Markers and Liver Cancer Markers between Hepatitis B Patients with HBsAg, HBeAg, and HBcAb Test Positive and HBsAg, HBeAb, and HBcAb Test Positive

摘要: 目的：分析乙肝“大三阳”和“小三阳”患者血清中HBV DNA载量、肝功能指标ALT和AST、肝纤维化标志物壳酶蛋白(CHI3L1)、肝癌标志物AFP。方法：选取448例乙肝患者作为研究对象，根据乙肝两对半结果分为两组：大三阳组(143例)、小三阳组(305例)，对两组患者的血清HBV DNA载量、ALT、AST、CHI3L1、AFP结果进行分析。采用卡方检验分析组间差异。结果：大三阳组的HBV DNA和ALT水平均明显高于小三阳组(P < 0.05)。大三阳组的CHI3L1水平明显低于小三阳组(P < 0.05)；CHI3L1水平在大三阳组和小三阳组均随年龄的升高而显著升高。随着HBV DNA载量的增加，两组患者的AFP水平逐渐升高；但相同的HBV DNA载量下，两组患者的AFP水平比较差异无统计学意义(P > 0.05)。结论：乙肝“大三阳”患者血清中HBV DNA载量和ALT明显高于“小三阳”患者，提示病毒复制更为活跃，传染性更强，肝功能损伤程度更高。肝癌标志物AFP与HBV DNA呈正相关，提示控制病毒载量的重要性。CHI3L1小三阳组反而高于大三阳组，提示肝纤维化与病程的相关性。

Abstract: Objective: To analyze HBV DNA load, liver function indexes of ALT and AST, liver fibrosis marker CHI3L1 and liver cancer marker AFP in patients with HBsAg, HBeAg, and HBcAb test positive (HBsAg+/HBeAg+/HBcAb+) and HBsAg, HBeAb, and HBcAb test positive (HBsAg+/HBeAb+/HBcAb+). Methods: 448 patients with hepatitis B were divided into two groups according to serological results: patients with HBsAg+/HBeAg+/HBcAb+ (143 cases) and patients with HBsAg+/HBeAb+/HBcAb+ (305 cases). The results of serum HBV DNA load, ALT, AST, CHI3L1 and AFP in the two groups were analyzed. Chi-square test was used to analyze the differences be-tween groups. Results: The levels of HBV DNA and ALT in patients with HBsAg+/HBeAg+/HBcAb+ were significantly higher than those in HBsAg+/HBeAb+/HBcAb+ group (P < 0.05). The level of CHI3L1 in HBsAg+/HBeAg+/HBcAb+ group was significantly lower than that in HBsAg+/HBeAb+/HBcAb+ group (P < 0.05). The level of CHI3L1 increased significantly with age in both groups. With the increase of HBV DNA load, the AFP levels of patients in the two groups gradu-ally increased. However, under the same HBV DNA load, there was no significant difference in AFP level between the two groups (P > 0.05). Conclusion: The serum HBV DNA load and ALT in patients with HBsAg+/HBeAg+/HBcAb+ are significantly higher than those in patients with HBsAg+/HBeAb+/HBcAb+ group, indicating more active virus replication, stronger infectivity, and higher degree of liver function damage. Liver cancer marker AFP level was positively correlated with HBV DNA load, suggesting the importance of viral load control. The CHI3L1 in patients with HBsAg+/HBeAb+/HBcAb+ was higher than that in the HBsAg+/HBeAg+/HBcAb+ group, suggesting that the progress of liver fibrosis was associated with disease course.