低水平HBsAg患者纤维化分期特征及其与血小板的相关性分析

摘要/Abstract

摘要： 目的了解低水平乙型肝炎表面抗原(HBsAg)慢性乙型肝炎(CHB)患者纤维化分期特征及其与血小板(PLT)计数的相关性。方法选取珠海市人民医院2018年4月至2020年4月收治的136例低水平HBsAg CHB患者,依据肝纤维化分期将患者分为S1期组(n=28)、S2期组(n=37)、S3期组(n=40)、S4期组(n=31)。患者入院后治疗前行PLT、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(CⅣ)、透明质酸(HA)、层粘连蛋白(LN)检测及肝纤维化分期评估。比较4组PLT、PC-Ⅲ、CⅣ、HA、LN水平差异。以Spearman系数检验低水平HBsAg CHB患者血清PLT水平与PC-Ⅲ、CⅣ、HA、LN水平的相关性。结果 S1期组PLT水平为(220.7±85.4)×10⁹/L,S2期组PLT水平为(169.2±66.4)×10⁹/L,S3期组PLT水平为(135.7±52.6)×10⁹/L,S4期组PLT水平为(104.5±40.1)×10⁹/L,差异有统计学意义(F=19.110,P<0.01)。S1期组血清PC-Ⅲ、CⅣ、HA、LN水平分别为(95.5±34.3)μg/mL、(61.2±15.7)μg/mL、(84.3±25.6)ng/mL、(88.4±15.4)ng/mL,S2期组血清PC-Ⅲ、CⅣ、HA、LN水平分别为(130.5±48.6)μg/mL、(79.3±20.4)μg/mL、(115.3±30.6)ng/mL、(102.8±22.8)ng/mL,S3期组血清PC-Ⅲ、CⅣ、HA、LN水平分别为(166.4±62.7)μg/mL、(90.4±25.3)μg/mL、(155.5±45.1)ng/mL、(115.6±29.3)ng/mL,S4期组血清PC-Ⅲ、CⅣ、HA、LN水平分别为(223.7±80.9)μg/mL、(105.5±31.9)μg/mL、(224.3±79.3)ng/mL、(226.3±34.0)ng/mL,差异均有统计学意义(F=25.737、17.828、46.166、175.093,均P<0.05)。经相关性分析,低水平HBsAg CHB患者血清PLT水平与PC-Ⅲ、CⅣ、HA、LN水平呈现出负相关,r=-0.584、-0.521、-0.499、-0.544,均P<0.01。结论低水平HBsAg CHB患者血清PLT水平呈现出明显的降低,血清PC-Ⅲ、CⅣ、HA、LN水平呈现出明显的上升,且两者间关系密切,有助于预测低水平HBsAg CHB患者肝组织损伤。

关键词: 慢性乙型肝炎, 乙型肝炎表面抗原, 肝纤维化分期, 血小板计数

Abstract: Objective To investigate the characteristics of fibrosis stage in chronic hepatitis B (CHB) patients with low level of hepatitis B surface antigen (HBsAg) and its correlation with platelet (PLT) count. Methods One hundred and thirty-six CHB patients with low HBsAg admitted to our hospital from April 2018 to April 2020 were included. They were divided into S1 group (n=28), S2 group (n=37), S3 group (n=40), and S4 group (n=31) according to the stage of liver fibrosis. At baseline, the PLT, type Ⅲ collagen (PC-Ⅲ), collagen type Ⅳ collagen (C Ⅳ), hyaluronic acid (HA), and laminin (LN) were detected in all patients.The stage of liver fibrosis was evaluated. The levels of PC, PC-Ⅲ, C Ⅳ, HA and LN of the four groups were compared, Spearman coefficient test was used to analyze the correlation between PLT level and PC-Ⅲ, C Ⅳ, HA and LN in CHB patients with low level of HBsAg. Results PLT levels of S1 group, S2 group, S3 group and S4 group were (220.7±85.4) × 10⁹/L, (169.2±66.4) × 10⁹/L, (135.7±52.6) × 10⁹/L, and (104.5±40.1) × 10⁹/L, respectively. The PLT level of the four groups from the highest to the lowest was in order as follows: S1 group, S2 group, S3 group, S4 group. The difference was statistically significant (P<0.05). Serum levels of PC-Ⅲ, C Ⅳ, HA, and LN of S1 group were (95.5±34.3) μg/mL, (61.2±15.7) μg/mL, (84.3±25.6) ng/mL, (88.4±15.4) ng/mL, respectively; of S2 group were (130.5±48.6) μg/mL, (79.3±20.4) μg/mL, (115.3±30.6) ng/mL, (102.8±22.8); of S3 group were (166.4±62.7) μg/mL, (90.4±25.3) μg/mL, (155.5±45.1) ng/mL, (115.6±29.3) ng/mL and of S4 group were (223.7±80.9) μg/mL, (105.5±31.9) μg/mL, (224.3±79.3) ng/mL, (226.3±34) ng/mL. The indicators of the four groups from the lowest to the highest was in order as follows: S1 group, S2 group, S3 group, S4 group, and the difference was statistically significant (P<0.05). Correlation analysis showed that serum PLT level was negatively correlated with the levels of PC-Ⅲ, C Ⅳ, HA and LN in CHB patients with low levels of HBsAg, r=0.584, 0.521, 0.499, 0.544, respectively, P<0.05. Conclusion When the serum PLT level decreases significantly, the levels of serum PC-Ⅲ, C Ⅳ, HA and LN rise obviously in CHB patients with low level of HBsAg, suggesting the close relationship between the level of HBsAg and PLT, which may help to evaluate liver histological damage.

Key words: Chronic hepatitis B, Hepatitis B surface antigen, Hepatic fibrosis stage, Platelet count

徐芳, 张海泉, 赵佳强. 低水平HBsAg患者纤维化分期特征及其与血小板的相关性分析[J]. 肝脏, 2021, 26(9): 977-979.

XU Fang, ZHANG Hai-quan, ZHAO Jia-qiang. The characteristics of fibrosis stage and its correlation with platelet in patients with low level HBsAg[J]. Chinese Hepatolgy, 2021, 26(9): 977-979.

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