慢性乙型肝炎患者肝细胞内HBsAg、HBcAg的表达与肝组织病理、血清HBV DNA定量关系

摘要

目的 探讨慢性乙型肝炎(CHB)患者肝细胞内HBsAg、HBcAg的表达与肝组织病理及血清 HBV DNA定量、肝组织HBV DNA定量之间的关系.方法 对188例CHB患者进行肝组织穿刺活检,采用免疫组化技术观察肝细胞内HBsAg、HBcAg的表达,采用HE染色及免疫组化染色.光镜观察肝炎活动度及纤维化程度,同时测定其肝组织及血清中HBV DNA含量.结果 在CHB患者肝组织内HBsAg和BcAg阳性表达率分别为95.7％和77.1％.HBsAg表达方式主要为胞浆型(98.3％); HBcAg表达方式为浆膜型和胞核型,分别为62.1％和37.9％,浆膜型组炎症活动度分级和纤维化分型均高于胞核型组(P＜0.05)；浆膜型组血清和肝组织的HBV DNA含量均显著高于胞核型组,二者比较差异有统计学意义(x2=8.214,P=0.042;x2=11.250,P=0.010).结论 在CHB患者肝组织免疫损伤发生的免疫应答中,HBcAg的表达方式与病毒的复制有关,与肝组织炎症、纤维化损伤有直接关系.肝组织中HBcAg的表达结合HBV DNA载量作为抗病毒治疗指标更为可靠.%Objective To study the correlation among the expression of HBsAg, HBcAg in hepatocytes and the pathology changes in liver tissue, the quantity of HBV DNA in serum and in the liver tissue in patients with chronic hepatitis B. Methods Expression of HBsAg and HBcAg in hepatocytes was assayed by using immuohistochemical staining. HE staining and immuohistochemical staining were used to identify the extent of liver inflammation and fibrosis and the quantity of HBV DNA in serum and liver tissue. At the time the pathological diagnosis was performed liver biopsy was performed in 188 CHB patients. Results The positive expression rates of HBsAg and HBcAg in liver tissue in CHB patients were 95.7% and 77.1 % , respectively. 98.3% of HBsAg expression was cytoplasm type, 62.1 % of HBcAg expression was cytoplasm membrance type and 37.9 % was nucleus type. The degree of liver inflammation amd fiborsis were both more serious in cytoplasm membrance type compared with nucleus type (Mann-whitney U = 1966. 500. 000, Wilcoxon W = 3506.500 P= 0.028 P<0.01; Mann-whitney U = 2005.500, Wilcoxon W = 3445.500 P = 0.045 P<0. 05). The quantity of HBV DNA in serum and liver were significantly higher in cytoplasm membrance type compared with nucleus type. There existed statistical differences(x2 = 8.214, P = 0.042; x2 = 11.250, P = 0.010). Conclusion The results suggest that HBcAg expression type is correlated with HBV replication, and liver inflammation and fibrosis in the immunopathogenesis of liver damage in CHB. HBcAg might be a reliable index to evaluate antivirus treatment.