Tan Lei, Xu Shi-Lei, Mo Zhi-Shuo, Liu Jian-Rong, Gan Wei-Qiang, Chen Jie-Huan, Gao Zhi-Liang, Wu Ze-Qian
Department of Medical Ultrasonic, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of General Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Ann Transl Med. 2021 Sep;9(18):1431. doi: 10.21037/atm-21-3846.
While serum hepatitis B surface antigens (HBsAg) play an important role in the diagnosis and assessment of treatment results of hepatitis B virus (HBV) infections, it remains unclear whether HBsAg levels normalized to hepatic parenchymal cell volume (HPCV) is a superior indicator of disease state. This study compared the absolute and HPCV-normalized serum HBsAg levels in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with chronic hepatitis B (CHB).
Patients admitted to our institution with CHB were retrospectively included and categorized into the HBeAg-positive and HBeAg-negative groups. HPCV was calculated based on pathological examination of liver biopsy specimens and theory of sphere geometry. The difference between HBsAg levels and HBsAg normalized to HPCV, and also correlation between HBsAg levels and liver inflammation and fibrosis was analyzed.
Absolute HBsAg levels (P=0.004), but not HPCV-normalized HBsAg levels (P=0.071) were significantly higher in HBeAg-positive patients compared to HBeAg-negative patients. In HBeAg-positive CHB patients, absolute HBsAg levels were positively correlated with liver inflammation grade (R=0.285, P=0.001) and hepatic fibrosis stage (R=0.351, P<0.001), as were HPCV-normalized HBsAg levels (R=0.640 and 0.742, both, P<0.001). However, in HBeAg-negative CHB patients, only HPCV-normalized HBsAg level were correlated with liver inflammation grade and hepatic fibrosis stage (R=0.640 and 0.785, both, P<0.001).
HPCV-normalized serum HBsAg levels, rather than absolute HBsAg levels, were positively correlated with liver inflammation grade and hepatic fibrosis stage in both HBeAg-positive and HBeAg-negative CHB patients. Thus, HPCV-normalized HBsAg levels may more accurately reflect the pathological progress of CHB patients compared to absolute HBsAg levels.
虽然血清乙肝表面抗原（HBsAg）在乙肝病毒（HBV）感染的诊断和治疗结果评估中发挥着重要作用，但尚不清楚以肝实质细胞体积（HPCV）标准化的HBsAg水平是否是疾病状态的更优指标。本研究比较了乙肝e抗原（HBeAg）阳性和HBeAg阴性慢性乙型肝炎（CHB）患者的绝对血清HBsAg水平以及经HPCV标准化的血清HBsAg水平。
回顾性纳入我院收治的CHB患者，并分为HBeAg阳性组和HBeAg阴性组。根据肝活检标本的病理检查结果和球体几何学理论计算HPCV。分析HBsAg水平与经HPCV标准化的HBsAg水平之间的差异，以及HBsAg水平与肝脏炎症和纤维化之间的相关性。
与HBeAg阴性患者相比，HBeAg阳性患者的绝对HBsAg水平显著更高（P = 0.004），但经HPCV标准化的HBsAg水平无显著差异（P = 0.071）。在HBeAg阳性的CHB患者中，绝对HBsAg水平与肝脏炎症分级（R = 0.285，P = 0.001）和肝纤维化分期（R = 0.351，P < 0.001）呈正相关，经HPCV标准化的HBsAg水平也如此（R分别为0.640和0.742，均P < 0.001）。然而，在HBeAg阴性的CHB患者中，只有经HPCV标准化的HBsAg水平与肝脏炎症分级和肝纤维化分期相关（R分别为0.640和0.785，均P < 0.001）。
在HBeAg阳性和HBeAg阴性的CHB患者中，经HPCV标准化的血清HBsAg水平而非绝对HBsAg水平与肝脏炎症分级和肝纤维化分期呈正相关。因此，与绝对HBsAg水平相比，经HPCV标准化的HBsAg水平可能更准确地反映CHB患者的病理进展。
