【摘要】 目的探讨乙肝病毒前S1抗原(PreS1)与乙肝病毒DNA(HBV DNA)、乙肝病毒标志物(HBVM)之间的相关性,为拉米夫定(Lamivudine)治疗提供新的监测指标。方法收集慢性乙型病毒性肝炎患者500例,其中HBV DNA阳性400例(拷贝数>500/ml),按HBV-DNA含量由低到高分8组;其余为HBVDNA阴性对照100例。同步以酶联免疫吸附试验(ELISA)法检测PreS1;以电化学免疫发光法检测乙肝病毒e抗原(HBeAg)、乙肝病毒e抗体(HBeAb)、乙肝病毒表面抗原(HBsAg);以荧光定量PCR法检测HBV DNA(以HBV DNA拷贝数>500/ml为阳性)。结果(1)在HBVDNA拷贝数500~1×106/ml之间,PreS1的阳性率比HBeAg高(P<0.05);在HBV DNA拷贝数1×106/ml以上,二者阳性率无显著性差异(P>0.05);(2)PreS1的灵敏度为90%(360/400),高于HBeAg的68.5%(274/400)(P<0.05);PreS1的阴性预示值为55.6%(50/90),高于HBeAg的43.2%(96/222)(P<0.05);PreS1的检测有效率为82.0%(410/500),高于HBeAg的64.8%(324/500)(P<0.05)。(3)在HBVDNA拷贝数500~1×104/ml之间,HBsAg的阳性率比PreS1高(P<0.05),在HBVDNA拷贝数1×104/ml以上,HBsAg的阳性率与PreS1的阳性率无显著性差异(P>0.05)。在HBVDNA拷贝数500~1×106/ml之间,HBeAb有较高的阳性率。结论PreS1与HBVDNA具有较好的相关性,其检测灵敏度和阴性预示值、检测有效率都优于HBeAg检测。PreS1可作为拉米夫定等抗病毒药物疗效观察指标之一。HBeAg阴性、HBeAb阳性不是传染性消失的可靠指标。更多还原

【Abstract】 Objective To observe the correlation of PreS1 with HBV DNA and HBV M, and provide a novel laboratory indication for treatment of patients with lamivudine. Methods Sera from 500 chronic B hepatitis patients were collected, 400 HBV DNA positive patients (HBV DNA >500 copies/ml) were divided into 8 groups based upon DNA levels and another 100 HBV DNA negative cases were taken as control. The Pre S1 (ELISA) and HBV M (electro-luminescence) both groups were determined. Results (1) The positive rate of PreS1 was higher than that of HBeAg (P<0.05) when HBV DNA level in sera varied from 500 to 1×10~6 copies/ml, and the PreS1was highly correlated with HBV DNA. while there is no significant differences between the positive rates of PreS1 and HBeAg when HBV DNA >1×10~6 copies/ml (P>0.05); (2)the sensitivity, negative predictive value (PV-) and efficiency in determined of preS1 in patients were 90%(360/400), 55.6%(50/90)and 82.0%(410/500),respectively higher than the sensitivity 68.5%(274/400), PV~- 43.2%(96/222) and efficiency 64.8%(324/500) in determination of HBeAg (P<0.05); (3)When HBV DNA level in sera changed from 500 to 1×10~4 copies/ml, the presence of HBsAg was higher than that of PreS1 (P<0.05).No significant differences between the positive rates of PreS1 and HBsAg were observed when HBV DNA >1×10~4 copies/ml (P>0.05). Conclusion Serum PreS1 closely correlates with HBV DNA and PreS1 is more sensitive and efficient than HBeAg. And serum PreS1 indicates a novel laboratory marker for antiviral drug therapy such as Lamivudine.更多还原