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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(yáng)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(cè),分為3組:無(wú)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(cè)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(yáng)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(yáng)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(shì)(P<0.05)。HBsAg水平、HBeAg陽(yáng)性率、抗HBV核心抗體陽(yáng)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(yáng)性且處于乙肝免疫耐受期患者,HBsAg濃度高、HBeAg陽(yáng)性率高及抗HBV核心抗體陽(yáng)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
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