【摘要】 目的 探讨乙肝感染不同阶段的乙肝核心相关抗原（hepatitis B core-related antigen, HBcrAg）水平及HBcrAg联合AFP、异常凝血酶原（protein induced by vitamin K absence-Ⅱ, PIVKA-Ⅱ）对乙肝相关肝癌的诊断价值。方法选取2019年10月至2021年3月首都医科大学附属北京佑安医院的HBsAg阳性患者562例，根据临床诊断分为慢乙肝组（173例）、肝硬化组（218例）、肝癌组（54例）和肝癌术后组（117例）；分别以HBsAg 3.0 Log IU/ml,HBcrAg 4.0 Log U/ml为界将所有患者分为4组，其中低HBsAg低HBcrAg组（142例）、低HBsAg高HBcrAg组（124例）、高HBsAg低HBcrAg组（31例）和高HBsAg高HBcrAg组（113例）。比较各组HBcrAg、AFP、PIVKA-Ⅱ等血清学标志物水平，采用ROC曲线评估HBcrAg、AFP和PIVKA-Ⅱ对乙肝相关肝癌的诊断价值。结果 562例患者中，男403例，女159例；年龄7～81岁，中位年龄51.0岁。临床诊断各组HBcrAg、AFP、PIVKA-Ⅱ等指标的比较，差异均有统计学意义（P<0.05）；低HBsAg高HBcrAg组肝癌患病比例为12.1%(15/124)，高于其他组（P<0.05）。HBcrAg、AFP和PIVKA-Ⅱ诊断HCC的ROC曲线的AUC分别为0.544(95%CI:0.473～0.613, P <0.05)、0.774(95%CI:0.712～0.829,P <0.05)和0.847(95%CI:0.790～0.893, P <0.05)，灵敏度分别为53.1%、66.7%和76.7%，特异性分别为61.7%、86.0%和87.3%；三者联合诊断HCC的ROC曲线的AUC为0.795(95%CI:0.697～0.893,P <0.05)，灵敏度为83.0%，特异性为67.0%。结论 肝癌组HBcrAg高于慢乙肝组、肝硬化组和肝癌术后组。在核苷类似物治疗情况下，HBcrAg单一指标不能很好地对肝癌进行预测，HBcrAg联合AFP、PIVKA-Ⅱ可提高肝癌诊断的灵敏度。更多还原

【Abstract】 Objective To explore the level of hepatitis B core-related antigen(HBcrAg) in different stages of HBV and the diagnostic value of HBcrAg combined with AFP and protein induced by vitamin K absence-Ⅱ(PIVKA-Ⅱ) in hepatitis B-related liver cancer. Methods A total of 562 patients with HBsAg positive in Beijing Youan Hospital Affiliated to Capital Medical University from October 2019 to March 2021 were selected, and were divided into chronic hepatitis B group(173 cases), cirrhosis group(218 cases), hepatocellular carcinoma group(54 cases) and postoperative hepatocellular carcinoma group(117 cases) according to the clinical diagnosis. The patients were divided into low HBsAg and low HBcrAg group(142 cases), low HBsAg and high HBcrAg group(124 cases), high HBsAg and low HBcrAg group(31 cases) and high HBsAg and high HBcrAg group(113 cases) according to the levels of HBsAg(3.0 Log IU/ml) and HBcrAg(4.0 Log U/ml).The levels of serum markers such as HBcrAg, AFP and PIVKA-Ⅱ were compared among the groups, and the diagnostic value of HBcrAg, AFP and PIVKA-Ⅱ for hepatitis B-related liver cancer was evaluated by ROC curve. Results Of the 562patients, 403 were male and 159 were female, the age from 7 to 81 years, and the median age was 51.0 years old. There were significant differences in HBcrAg, AFP, PIVKA-Ⅱ among all groups(all P < 0.05). The proportion of hepatocellular carcinoma in low HBsAg and high HBcrAg group was 12.1%(15/124), which was higher than that in other groups(P <0.05). The AUC of the ROC curves of HBcrAg, AFP and PIVKA-Ⅱ in the diagnosis of HCC were 0.544(95%CI: 0.473-0.613, P < 0.05), 0.774(95%CI: 0.712-0.829, P < 0.05) and 0.847(95%CI: 0.790-0.893, P < 0.05), respectively, with a sensitivity of 53.1%, 66.7% and 76.7%, respectively and a specificity of 61.7%, 86.0% and 87.3%, respectively. The AUC of the ROC curves of HBcrAg combined with AFP and PIVKA-Ⅱin the diagnosis of HCC was 0.795(95%CI: 0.697-0.893,P < 0.05), with a sensitivity of 83.0% and specificity of 67.0%. Conclusions The HBcrAg of hepatocellular carcinoma group is higher than that of chronic hepatitis B group, cirrhosis group and postoperative hepatocellular carcinoma group. In the case of nucleoside analogues, HBcrAg alone is not a good predictor of liver cancer, HBcrAg combined with AFP and PIVKA-Ⅱ can improve the diagnostic sensitivity of hepatocellular carcinoma.更多还原