The Study On The Correlation Between HBsAg Levels And Liver Inflammation And Fibrosis In Chronic Hepatitis B Infection With Normal ALT

Objective:To analyze the correlation between serum HBs Ag level and liver pathological change in patients with chronic hepatitis b virus(HBV)infected with ALT,and to explore the predictive value of serum HBs Ag level on liver inflammation and fibrosis.Methods:Select 121 cases of chronic HBV infection with normal ALT by pathological examination of liver biopsy.The levels of HBs Ag,and HBe Ag in patients were detected by chemiluminescent microparticle immunoassay.HBV DNA levels were detected by real-time fluorescent quantitative PCR assays,and the correlation between HBs Ag levels and liver inflammation and fibrosis was analyzed.Using SPSS 17.0 software,Mann-Whitney U test was used to analyze the difference of serum HBs Ag and HBV DNA levels between HBe Ag positive and negative patients.Correlations between serum HBs Ag levels and HBV DNA levels and hepatic inflammation and fibrosis were analyzed by Spearman rank correlation.The differences in serum HBs Ag levels and HBV DNA levels in different liver inflammation grades and fibrotic stages were analyzed by one-way ANOVA.The serum HBs Ag and HBV DNA levels were evaluated by ROC curve method to predict the degree of inflammatory activity and fibrosis in liver tissue.The maximal Youden index was used to determine serum HBs Ag levels and HBV DNA levels to predict the best cutoff values for different degrees of inflammatory activity and fibrosis in liver tissue.Results: 1.The serum HBs Ag level of 121 patients with normal ALT normal HBV infection was 3.62±1.04 lg IU/m L.HBe Ag positive serum HBs Ag levels(4.34± 0.55 lg IU/m L vs.3.05±0.98 lg IU/m L,P = 0)was significantly higher than that of HBe Ag negative.HBe Ag positive HBVDNA level(7.46±1.42 lg IU/m L vs.3.51±1.43 lg IU/m L,P = 0)was also significantly higher than that of HBe Ag negative.2.Chronic HBV infection in 121 cases of normal ALT,serum level of HBs Ag and liver fibrosis stage was significantly negative correlation(r = 0.259,P < 0.05),there was no significant correlation with liver inflammation grading(P > 0.05).HBe Ag positive group showed significant negative correlation between HBs Ag level and liver inflammation grade and fibrosis stage(P<0.05).HBV DNA level was also significantly negatively correlated with liver inflammation grading and fibrosis staging(P<0.05).HBe Ag negative groups,HBs Ag level classification with liver inflammation and fibrosis stage had no significant correlation(P > 0.05).HBV DNA levels and liver inflammation grading was significantly positive correlation(r = 0.479,P = 0),there was no significant correlation with the liver fibrosis stage(P > 0.05).3.It was found that that difference between the level of serum HBs Ag and HBVDNA in different inflammatory stage and fibrosed stage were statistically significant(P < 0.05).HBe Ag negative group,serum HBs Ag in different liver inflammation grading,and the differences between the fibrosis stage had no statistical significance(P > 0.05).HBVDNA level between different liver inflammation grade difference was statistically significant(P < 0.05),the differences between different liver fibrosis stage has no statistical significance(P > 0.05).4.In HBe Ag-positive patients,serum HBs Ag levels had predictive value for inflammation grade?G2 and fibrosis stage?S2(P<0.05).The HBVDNA level had predictive value for inflammation grade?G2 and fibrosis stage?S2(P<0.05).In HBe Ag-negative patients,serum HBs Ag levels had no predictive value for inflammation grade?G2 and fibrosis stage?S2(P>0.05).The HBVDNA level had predictive value for inflammation grade?G2 and fibrosis stage?S2(P<0.05).5.Chronic HBV infection in 121 cases of normal ALT,serum HBs Ag levels were significantly negative correlation with age(r = 0.227,P < 0.05).6.HBe Ag positive group,serum HBs Ag level in the group with age <30 years and age > 30 years of age group,the level of inflammation was greater than that of G2 and fibrosis stage,both of which had predictive value(P<0.05).The level of HBVDNA in the group with age <30 years and age > 30 was also predicted(P<0.05).7.It was found that that HBe Ag positive age group was low than the group of 30 years,with serum HBs Ag lat or less than 4.322 lg IU/m L as standard,and its sensitivity,specificity,udene index and accuracy were 1,0.9,0.9 and 93.3% respectively.On the basis of serum HBs Ag 3.898 lg IU/m L or less,its predictions fibrosis stage of S2 or degree of sensitivity,specific,Youden index,accuracy of 1,0.917,0.917,93.3% respectively.It was found that that HBe Ag positive age group was not less than the age group of 30 and was use as standard in serum HBs Ag lolor lr than 4.698 lg IU/m L,and its sensitivity,specificity,udene index and accuracy were 0.917,0.556,0.4773 and 66.7% respectively.Serum HBs Ag 4.023 lg IU/m L or less as the standard,the predicting fibrosis stage of S2 or degree of sensitivity,specific,Youden index,the accuracy of 0.75,0.839,0.589 and 82.1% respectively.Conclusion:1.The lower the level of serum HBs Ag in patients with chronic HBV infection with normal ALT,the heavier the liver fibrosis.2.In patients with chronic HBV infection with normal ALT,serum HBs Ag levels and HBV DNA levels are higher in HBe Ag-positive patients than in HBe Ag-negative patients.3.HBe Ag-positive,chronic HBV-infected individuals <30 years of age,serum HBs Ag ? 4.322 lg IU/m L suggest liver inflammation grade ? G2;HBV DNA ? 3.898 lg IU/m L suggest liver fibrosis staging ? S2.HBe Ag-positive,aged ? 30-year-old patients with chronic HBV infection,serum HBs Ag ? 4.698 lg IU / m L prompted liver inflammation grade ? G2;HBV DNA ? 4.023 lg IU / m L prompted liver fibrosis stage ? S2.