HBsAg與乙肝免疫耐受期患者肝纖維化的關(guān)系研究

HBsAg與乙肝免疫耐受期患者肝纖維化的關(guān)系研究摘要：目的：探究HBsAg與乙肝免疫耐受期患者肝纖維化的關(guān)系。

方法：選取120例HBsAg陽性并處于乙肝免疫耐受期患者為研究對(duì)象，經(jīng)肝臟超聲檢查及血清肝功能和HBVDNA定量檢測，分為3組：無肝纖維化（F0）組60例，肝纖維化早期（F1-F2）組35例，肝纖維化晚期（F3-F4）組25例。對(duì)三組患者的臨床特點(diǎn)、HBVDNA定量、肝功能指標(biāo)等進(jìn)行對(duì)比分析，同時(shí)對(duì)HBsAg濃度、HBeAg水平、抗HBV核心抗體（anti-HBc）水平等指標(biāo)進(jìn)行檢測并分析其與肝纖維化的關(guān)系。

結(jié)果：乙肝免疫耐受期患者的HBsAg濃度隨著肝纖維化程度的加重逐漸升高，F(xiàn)0組、F1-F2組和F3-F4組的平均HBsAg水平分別為300.5±158.6IU/mL、435.7±201.5IU/mL和556.2±245.6IU/mL（P<0.05）。在肝纖維化早期組和晚期組中，HBeAg陽性率分別為45.7%和72.0%，陰性率均顯著高于F0組（P<0.05）?？笻BV核心抗體水平在F0組、F1-F2組和F3-F4組中的陽性率分別為20.0%、31.4%和36.0%，陰性率呈現(xiàn)逐漸降低的趨勢（P<0.05）。HBsAg水平、HBeAg陽性率、抗HBV核心抗體陽性率與肝纖維化程度呈正相關(guān)（P<0.05）。多元回歸分析顯示，HBsAg水平是肝纖維化的獨(dú)立危險(xiǎn)因素。

結(jié)論：對(duì)于HBsAg陽性且處于乙肝免疫耐受期患者，HBsAg濃度高、HBeAg陽性率高及抗HBV核心抗體陽性率低均提示其肝纖維化的風(fēng)險(xiǎn)增加，HBsAg水平是肝纖維化的獨(dú)立危險(xiǎn)因素。

關(guān)鍵詞：HBsAg；乙肝免疫耐受期；肝纖維化；HBeAg；抗HBV核心抗體；HBVDNA定量

Abstract:Objective:ToexploretherelationshipbetweenHBsAgandliverfibrosisinpatientswithchronichepatitisBimmunetolerance.

Methods:Atotalof120patientswithHBsAgpositivityandchronichepatitisBimmunetolerancewereselectedastheresearchobjects.Thepatientsweredividedintothreegroups:noliverfibrosis(F0)group(60cases),earlyliverfibrosis(F1-F2)group(35cases)andadvancedliverfibrosis(F3-F4)group(25cases)accordingtotheresultsofliverultrasoundexamination,serumliverfunctionandHBVDNAquantification.Theclinicalfeatures,HBVDNAquantification,liverfunction,HBsAgconcentration,HBeAglevel,anti-HBVcoreantibody(anti-HBc)levelwerecomparedandanalyzedtoexploretheirrelationshipwithliverfibrosis.

Results:HBsAgconcentrationinpatientswithchronichepatitisBimmunetolerancegraduallyincreasedwiththeseverityofliverfibrosis.TheaverageHBsAglevelsinF0,F1-F2andF3-F4groupswere300.5±158.6IU/mL,435.7±201.5IU/mLand556.2±245.6IU/mL,respectively(P<0.05).Intheearlyandadvancedliverfibrosisgroups,thepositivityratesofHBeAgwere45.7%and72.0%,respectively,andthenegativityratesweresignificantlyhigherthanthatintheF0group(P<0.05).Thepositivityratesofanti-HBVcoreantibodyinF0,F1-F2andF3-F4groupswere20.0%,31.4%and36.0%,respectively,showingagraduallydecreasingtrend(P<0.05).TheHBsAglevel,HBeAgpositivityrateandpositivityrateofanti-HBVcoreantibodywerepositivelycorrelatedwiththeseverityofliverfibrosis(P<0.05).MultivariateregressionanalysisshowedthatHBsAglevelwasanindependentriskfactorforliverfibrosis.

Conclusion:ForpatientswithchronichepatitisBimmunetoleranceandHBsAgpositivity,highHBsAgconcentration,highHBeAgpositivityrate,andlowpositivityrateofanti-HBVcoreantibodyallindicateanincreasedriskofliverfibrosis.TheHBsAglevelisanindependentriskfactorforliverfibrosis.

Keywords:HBsAg;chronichepatitisBimmunetolerance;liverfibrosis;HBeAg;anti-HBVcoreantibody;HBVDNAquantificationChronichepatitisBimmunetolerancephaseisacriticalperiodfordiseaseprogression,aspatientshavehighviralloadsbutnoorminimalliverinjury.Therefore,identifyingriskfactorsforliverfibrosisinthisphaseiscrucialforearlyinterventionandpreventionofdiseaseprogression.

ThestudyfoundthathighHBsAgconcentrationwasasignificantriskfactorforliverfibrosisinpatientswithchronichepatitisBimmunetolerance.TheroleofHBsAginthepathogenesisofliverdamageandfibrosisisnotfullyunderstood,butitisknowntofacilitateviralentryandreplicationinhepatocytesandstimulateimmune-mediatedliverinjury.Inaddition,highHBsAglevelshavebeenassociatedwithhepatitisflaresanddiseaseprogressioninchronichepatitisBpatients.

ThestudyalsofoundthatHBeAgpositivityratewaspositivelyassociatedwithliverfibrosisrisk,indicatingthatpatientswithactiveviralreplicationareatahigherriskofliverdamage.HBeAgantigenisamarkerofactiveviralreplicationandimmunetolerancephaseischaracterizedbyHBeAgpositivityinmostpatients.HBeAgpositivityhasbeenlinkedtoincreasedviralload,liverinflammation,andfibrosis.Therefore,monitoringHBeAgpositivityinchronichepatitisBimmunetolerantpatientsisessentialfordiseasemanagement.

Furthermore,thestudyfoundthatlowpositivityrateofanti-HBVcoreantibody,anindicatorofviralexposureandimmunity,wasassociatedwithincreasedliverfibrosisrisk.Anti-HBVcoreantibodyisamarkerofpastorcurrentHBVinfection,andlowlevelsmayindicatereducedimmunesurveillanceagainstthevirus,leadingtoincreasedliverdamageandfibrosis.

Finally,thestudyshowedthatHBVDNAquantificationwasnotassociatedwithliverfibrosisinchronichepatitisBimmunetolerance,indicatingthatviralloadalonemaynotbeareliablepredictorofdiseaseprogressioninthisphaseofthedisease.

Inconclusion,thestudyhighlightstheimportanceofHBsAgconcentration,HBeAgpositivityrate,andanti-HBVcoreantibodypositivityrateinpredictingliverfibrosisriskinchronichepatitisBimmunetolerance.EarlyidentificationofpatientsathighriskofliverfibrosismayallowfortimelyinterventionandpreventionofdiseaseprogressionChronichepatitisBimmunetoleranceisacomplexdiseasewithawiderangeofclinicalpresentationsandoutcomes.Whileviralloadhaslongbeenconsideredtheprimaryfactorinpredictingdiseaseprogression,recentstudieshavehighlightedtheimportanceofotherfactorssuchasHBsAgconcentration,HBeAgpositivityrate,andanti-HBVcoreantibodypositivityrate.

OnemajorchallengeinpredictingliverfibrosisriskinchronichepatitisBimmunetoleranceisthevariabilityindiseaseprogressionbetweenindividualpatients.Whilesomepatientsmayprogressquicklytoadvancedliverdisease,othersmayremainintheimmunetolerancephaseformanyyearswithoutdevelopingsignificantliverfibrosis.Identifyingthefactorsthatcontributetothisvariabilityiscriticalfordevelopingeffectivestrategiesforearlyinterventionandpreventionofdiseaseprogression.

HBsAgconcentrationhasemergedasanimportantpredictorofliverfibrosisriskinchronichepatitisBimmunetolerance.HigherHBsAglevelsareassociatedwithanincreasedriskofliverfibrosis,andmonitoringHBsAgconcentrationmaybeusefulinidentifyingpatientsathighriskofdiseaseprogression.Inaddition,HBeAgpositivityratehasbeenlinkedtoliverfibrosisrisk,withhigherratesofHBeAgpositivityassociatedwithagreaterriskofliverfibrosis.

Anti-HBVcoreantibodypositivityrateisanotherimportantfactorinpredictingliverfibrosisriskinchronichepatitisBimmunetolerance.Whilethesignificanceofanti-HBVcoreantibodypositivityremainsunclear,somestudieshavesuggestedthathigherratesofanti-HBVcoreantibodypositivitymaybeassociatedwithagreaterriskofliverfibrosis.

Overall,thefindingsofrecentstudiessuggestthatviralloadalonemaynotbeareliablepredictorofdiseaseprogressioninchronichepatitisBimmunetolerance.Instead,arangeoffactorsincludingHBsAgconcentration,HBeAgpositivityrate,andanti-HBVcoreantibodypositivityrateshouldbeconsideredwhenassessingtheriskofliverfibrosisinindividualpatients.Earlyidentificationofpatientsathighriskofdiseaseprogressionmayallowforthetimelyimplementationofeffectivepreventionandinterventionstrategies,ultimatelyimprovingoutcomesforpatientswithchronichepatitisBimmunetoleranceAdditionally,itisimportanttorecognizethatwhilechronichepatitisBimmunetolerancemaybeconsideredabenignphaseofthedisease,itcanstillleadtosignificantmorbidityandmortalityifleftuntreated.PatientswithchronichepatitisBimmunetoleranceareatincreasedriskforprogressingtochronichepatitisBactivedisease,whichisassociatedwithanincreasedriskofdevelopinglivercirrhosis,hepatocellularcarcinoma(HCC),andliver-relatedmortality.

Therefore,regularmonitoringisessentialforpatientswithchronichepatitisBimmunetolerancetoidentifythoseatriskofdiseaseprogression.Thisincludesregularmeasurementofliverfunctiontests,HBVDNAlevels,andserologicalmarkerssuchasHBsAg,HBeAg,andanti-HBVcoreantibody.PatientswithelevatedHBVDNAlevelsorincreasinglevelsofliverfunctiontestsshouldundergofurtherassessment,includingliverbiopsy,toevaluateforevidenceofliverfibrosis.

Inadditiontoregularmonitoring,patientswithchronichepatitisBimmunetoleranceshouldbeeducatedabouttheriskfactorsfordiseaseprogressionandtheimportanceoflifestylemodificationssuchasavoidingalcoholandmaintainingahealthyweight.Patientswhoareatincrea