中文摘要：

目的探讨慢洼乙型肝炎病毒感染者血清HBsAg和HBVDNA定量水平与肝脏纤维化程度的相关性。方法302例接受肝穿刺活组织检查的慢性乙型肝炎（CHB）患者被纳入研究，定量检测血清HBsAg、HBV DNA水平和总胆红素（TBil）、ALT、AST和血小板（PLT），并计算出AST-PLT比值指数（APRI）；采用GS分期评估肝脏炎症、纤维化程度，分析HBsAg、HBV DNA定量水平等临床指标与肝组织纤维化程度的相关性。计量资料组间比较采用f检验与方差分析；判断HBsAg、HBV DNA水平和肝纤维化程度之间的关系采用Spearman相关分析；采用多因素非条件logistic回归分析筛选肝纤维化程度的影响因素。结果随着肝纤维化程度的逐渐加重，PLT、HBsAg与HBVDNA定量水平逐步降低，APRI指数逐步升高，各组间差异有统计学意义旷值分别为7．19，3．62，15．39，21．80，P值均〈0．01）；经Spearman相关分析，HBsAg水平与HBVDNA水平存在密切正相关（，=0．721，P〈0．01）。与轻微肝纤维化（S0-1）的HBeAg阳性患者相比较，中、重度肝纤维化（S2—4）的HBeAg阳性患者HBsAg水平和HBV DNA水平显著降低（t值为5．475和4．826，P值均〈0．01）。ROC曲线分析数据显示：HBsAg〉4．46log10拷贝／ml的截断值（28800U／ml），用于预测肝纤维化S0-1级的敏感度为76．3％，特异度为70．5％;HBV DNA〉7．13log10拷贝／ml的截断值（1．35×107拷贝／ml），用于预测肝纤维化S0-1级的敏感度为71．1％，特异度为73．4％。logistic回归分析显示：在性别、年龄、HBsAg定量对数、HBV DNA定量对数、ALT、AST、PLT等因素中，HBsAg水平是中、重度肝纤维化的独立预测因素垆〈0．01）。结论HBsAg、HBV DNA水平随肝纤维化程度加重逐渐降低，其中HBsAg水平以28800U／ml和HBVDNA水平以1．35×107拷贝／ml为截断值预测HBeAg阳性患者肝纤维化程度的特异度和灵敏度较高；HBsAg水平是中?

英文摘要：

Objective To explore the correlaon between serum hepatitis B surface antigen （HBsAg） level and hepatic tissue pathological staging in patients with chronic hepatitis B （CHB）. Methods Clinical data was collected from our hospital＇s records for 302 CHB patients with HBsAg-positive status for more than 6 months and who had undergone hepatic biopsy. The HBsAg level, HBV DNA level and other clinical data were measured using commercial diagnostic assays. Liver lfistology was scored using the GS staging system Correlation between serum HBsAg quantity, HBV DNA quantity, stage of inflammation and degree of fibrosis was assessed statistically. Results The correlation of serum HBsAg level and HBV DNA level was notable. The serum HBsAg level was a variable affecting hepatic tissue pathological stage significantly. Serum HBsAg level appeared to be a highly specific and sensitive diagnostic marker of hepatic fibrosis. As the severity of liver fibrosis increased, the quantitative levels of platelet （PLT）, HBsAg and HBV DNA gradually decreased, and the APRI index gradually increased; there were significant differences between the groups （allP 〈 0.001）. Serum HBsAg and HBV DNA levels in patients with hepatitis B e antigen-positive （HBeAg（＋）） status showed slrong correlation （r = 0.721, P 〈 0.0001 ） by Spearman analysis. HBe Ag（ ＋ ） patients with moderate to severe fibrosis （S2-4） exhtoited significantly lower serum HBsAg and HBV DNA levels compared with patients with no or mild fibrosis （SO- 1; t = 5.475 and 4.826, P 〈 0.001 ）. ROC analysis suggested that a serum HBsAg cutoff of 4.46 log 10IU/mL （28 800 IU/mL） would provide a theoretical sensitivity of 76.3%, with theoretical specificity of 70.5% in HBeAg（＋） CHB patients. A serum HBV DNA cutoff of 7.13 log 10IU/mL （1.35×107 copies/mL） would provide a theoretical sensitivity of 71.1%, with theoretical specificity of 73.4% in HBeAg（＋） CHB patients. Logistic regression analysis showed that the level of HBsAg wa