HBsAg定量检测对慢性重型乙型肝炎患者预后的预测价值

Objective To investigate the value of HBs Ag quantification in predicting the prognosis of patients with chronic severe hepatitis B. Methods The clinical data of 61 patients with chronic severe hepatitis B who were admitted to The First Hospital of Jilin University from January 2012 to August 2015 were analyzed retrospectively and were followed up for 90 days. Chemiluminescent microparticle immunoassay was used to measure the serum HBs Ag level. The receiver operating characteristic curves were used to determine the cut- off value of HBs Ag,and according to this value,the patients were divided into HBs Ag < 1. 63 log10 IU / ml group,1. 63- 2. 61 log10 IU / ml group,2. 61-3. 62 log10 IU / ml group,and HBs Ag > 3. 62 log10 IU / ml group. The Kruskal- Wallis test was used for comparison of continuous data between multiple groups,the Mann- Whitney U test was used for comparison of continuous data between two groups,and the Fisher' s exact test was used for comparison of categorical data between groups. The log- rank test was used for comparison of survival curves between multiple groups. The univariate and multivariate Cox regression analyses were used to analyze the factors related to the prognosis of chronic severe hepatitis B and obtain the hazards ratio( HR) of each variable. The Spearman correlation analysis was used for correlation analysis. Results The survival time showed a significant difference between the four groups( χ~2= 18. 261,P < 0. 001). The HBs Ag < 1. 63 log10 IU / ml group had a significantly lower 90- day survival rate than the 2. 61- 3. 62 log10 IU / ml group( χ~2= 10. 283,P = 0. 001) and the HBs Ag >3. 62 log10 IU / ml group( χ~2= 17. 236,P < 0. 001). The multivariate Cox regression analysis showed that HBs Ag( HR = 0. 562,95% CI:0. 364- 0. 870,P = 0. 010),blood urea nitrogen( HR = 1. 111,95% CI: 1. 042- 1. 185,P = 0. 001),hepatic encephalopathy( HR =4. 123,95% CI: 1. 729- 9. 830,P = 0. 001),and Model for End- Stage Liver Disease( MELD) score( HR = 1. 093,95% CI: 1. 024~(-1). 166,P = 0. 007) were independent risk factors for the 90- day survival rate of patients with chronic severe hepatitis B. HBs Ag showed a low correlation with HBV DNA( r = 0. 326,P = 0. 01). Conclusion Serum HBs Ag level is an important factor in predicting the prognosis of patients with chronic severe hepatitis B.