Association Between Serum HBV DNA And Alpha Fetoprotein And The Analysis Of The Influencing Factors For Serological Transformation Of Hepatitis B E Antigen In Patients With Primary Liver Cancer After HBV Infection

Objectives:To analyze the medical records and laboratory examination results in patients with primary hepatic cancer after HBV infection to improve the characteristics of this group,in order to provide a theoretical basis for the early clinical detection of high-risk patients with primary hepatic cancer.Methods:Clinical data of 884 patients diagnosed with primary liver cancer who were hospitalized in the first affiliated hospital of medical college of Zhejiang university from January 2011 to January 2018 were selected and a control group was set up according to inclusion and exclusion criteria.Demographic data,laboratory examination,imaging examination,and treatment after admission were collected.The patients were divided into different groups according to the stage of HBV infection to PLC(pure carriers/hepatitis/cirrhosis),HBV DNA level(low level/medium level/high level),age(<40 years old/≥40 years old),HBeAg status(negative/positive),etc.Mainly to analyze the relationship between serum HBV DNA and alpha fetoprotein and the related factors of negative conversion or serological conversion of hepatitis B e antigen(HBeAg)as well as the other characteristics of the population,884 patients with PLC after HBV infection were studied.SPSS version 20.0 was used for statistical analysis.Results:The mean age and gender composition of 884 patients with PLC after HBV infection were statistically significant.The sex ratios of males and females in the pure carrier group,hepatitis group and liver cirrhosis group were significantly different and the ratios were gradually increased,which were 2.5:1,3.5:1 and 8:1,respectively.16.9%of HBV infected patients did not go through the cirrhosis stage and directly developed into PLC from simple carriers or chronic hepatitis.All patients in the study group had up to 12 hepatitis B virus markers(HBV-M)patterns,the most common hepatitis B virus marker(HBV-M)pattern was "small three positive"(552 cases,62.4%),followed by"big three positive"(217 cases,24.5%),and the third is positive hepatitis B surface antigen(HBsAg)and hepatitis B core antibody(HBcAb)(60 cases,6.8%).Comparing the relationship between HBV-M and HBV DNA,the number of patients with high HBV DNA level in the "small three positive" model was significantly different between the research group and the control group(p=0.003),while the number of patients with high HBV DNA level in the "big three positive" model was not significantly different between the two groups(p=0.373).The peak age of patients was 50-59 years old,with a total of 293 cases(33.1%).The average value of AFP reached a peak in the age group of 30-39 years old,and then the average value of AFP in HBeAg negative patients gradually showed a downward trend.The trend of HBeAg positive patients was basically similar,but in the age group of 50-59 years old,the average value of AFP rose again,and then continued to decline.The change trend of liver function index of all patients in the study group was basically consistent with the development process of liver cancer from "carrier→hepatitis→cirrhosis".Grouping analysis of liver function indicators,the liver function index of the three groups tended to deteriorate successively.The liver function indexes of all patients were analyzed in groups.Among the pure carriers group,the mean values of ALT,TBIL,GLB and ALP of patients aged<40 years and>40 years were statistically significant.In the hepatitis group,the average GLB and AFP values of the two age groups were significantly different.In the cirrhosis group,the differences in TBIL,ALB and GLB mean values between the two age groups were statistically significant.There were 259 patients with positive HBeAg,107 patients with negative HBeAg conversion or serological conversion,and the conversion rate was 41.3%.Analysis showed that age,HBV DNA level,and whether final surgical or interventional treatment were associated with HBeAg negative conversion or serological conversion(all p<0.001).Selection of surgical or interventional intervention means had no effect on HBeAg negative conversion or serological conversion(p=0.638).Qualitative analysis of the relationship between AFP level and HBV DNA level with the chi-square testshowed that X2=31.86,p<0.001,Cramer’s V=0.19,The results indicated that there was a weak positive correlation between HBV DNA level and AFP level.Patients with low HBV DNA level were more likely to have negative AFP level,while patients with high HBV DNA level were more likely to have positive AFP level.There was no significant correlation between AFP level and HBV DNA level in patients with high HBV DNA level.Quantitative analysis of the relationship between AFP level and HBV DNA level.Pearson correlation analysis results showed that there was a very weak positive correlation between HBV DNA level and AFP level(r=0.190,p<0.001).Further grouping analysis showed that there was a strong positive correlation between HBV DNA and AFP level in the pure carriers with age<40 years old group(r=0.631,p=0.028).In the hepatitis with age≥40 years group,there was a weak positive correlation between HBV DNA and AFP levels(r=0.234,p=0.036).In the cirrhosis with age≥40 years group,there was a very weak positive correlation between HBV DNA and AFP levels(r=0.106,p<0.017).Conclusions:PLC can occur in all stages of HBV infection and all HBV-M mode,so monitoring and early prevention should be strengthened;The risk of PLC occurrence in the following categories of patients should be paid attention to:(1)female carriers or female hepatitis patients(2)abnormal liver function in middle-aged and elderly carriers(3)HBeAb positive patients(4)HBV infected patients at high level of HBV DNA after serological conversion;ALB and GLB should be taken into account in evaluating the condition of PLC patients after HBV infection;Low age,low level of HBV DNA,surgical operation or interventional therapy are the three influencing factors of HBeAg negative conversion or serological conversion in PLC patients after HBV infection,different types of surgical or interventional interventions have no effect on HBeAg negative or serological conversion;There is a certain correlation between HBV DNA and AFP in HBV infected persons,especially in young and middle-aged carriers,there is a strong positive correlation between HBV DNA level and AFP level,the risk of PLC can be roughly assessed by the level of HBV DNA for early detection of PLC patients.