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目的:对乙肝病毒血清学标志物HBV-M(包括HBsAg、HBsAb、HBeAg、HBeAb、HBcAb),乙肝病毒外膜大蛋白(HBV-Lp),乙肝病毒前S1抗原(HBV-Pres1)和乙肝病毒脱氧核糖核酸(HBV-DNA)联合检测结果进行比较,观察乙肝病毒外膜大蛋白(HBV-Lp)检测在临床诊断治疗乙肝中的应用价值,寻求比现有常规检测更敏感、更准确的实验室乙肝检测方法.方法:将感染科461例标本分成5组进行比较分析:78例乙肝表面抗原(吸收度A值＜1)阴性血清标本为A对照组;9例HBsAg弱阳性(吸收度A值为1～2)血清标本为B组;201例HBsAg阳性(吸收度A值＞2)且HBV-DNA含量＜5×102IU/ml的血清标本为C组;133例HBsAg阳性(吸收度A值＞2)且HBV-DNA含量5×102～5×105IU/ml的血清标本为D组;40例HBsAg阳性(吸收度A值＞2)且HBV-DNA含量＞5×105IU/ml的血清标本为E组.用酶联免疫吸附法检测HBV-M,HBV-Lp和HBV-Pres1,PCR-荧光探针法定量检测HBV-DNA.结果:A组和B组未见Pre-S1和HBV-LP结果异常.C、D、E组中HBeAg的阳性率依次为0.99％,6.02％,77.50％;Pre-S1的阳性率依次为29.35％,42.86％,90.00％;HBV-LP的阳性率依次为38.31％,55.64％,95.00％,HBV-LP、HBeAg和Pre-S1的阳性率可能性均随着HBV-DNA含量的增加而增大(P＜0.05).C、D、E组中HBeAg、Pre-S1和HBV-LP的检出率分别为10.96％, 40.64％, 50.53％,HBV-LP的检出率明显高于HBeAg和Pre-S1的检出率(P＜0.05).通过对相同HBV-DNA含量组的HBV-LP、HBeAg和Pre-S1阳性率进行统计学t检验比较,可以看出HBV-LP的检出率明显高于HBeAg和Pre S1的检出率(P＜0.05).C、D、E组中HBV-LP的平均吸收度A值依次为2.53,5.35,13.93.HBV-DNA含量的增加伴随着有HBV-LP浓度的增加(P＜0.05).结论:HBV-LP检测比HBeAg和Pre-S1检测敏感性强,被检出的可能性更大,漏检的可能性更小.HBV-LP检测与HBV-DNA检测呈正相关性,HBV-LP在HBsAg阳性而HBV-DNA检测阴性时有理想的检出率,可能会对乙型肝炎诊断治疗进行补充作用.“,”Objective : By comparing the result of serological markers for hepatitis B virus HBV-M (including HBsAg, HBsAb, HBeAg, HBeAb, HBcAb), hepatitis B virus large outer membrane protein( HBV-Lp), former S1 antigen hepatitis B virus(HBV Pres1)and hepatitis B virus DNA(HBV DNA),observe the value of hepatitis B virus large outer membrane protein(HBV-Lp) in the clinical diagnosis and treatment of viral hepatitis B, to seek a more sensitive and accurate method of laboratory testing than the existing conventional detection. Method:The 461 specimens from the Infectious Disease Department of the hospital were divided into five groups for comparison and analysis:78 cases of serum specimens with HBsAg negative(absorbance A value is＜l)for control group A;9 cases of serum specimens with HBsAg weak positive(absorbance A value is 1-2) were in group B; 201 cases of serum specimens with HBsAg positive(absorbance A value is＞2)and HBV-DNA content＜5 × 102 IU/ml were in group C; 133 cases of serum specimens with HBsAg positive(absorbance A value is＞2)and HBV-DNA content 5 × 102-5 × 105 IU/ml were in group D; 40 serum samples with HBsAg positive(absorbance A value is＞2) and HBV-DNA content＞5 × 105 IU/ml were group E. HBV-M, HBV-Lp and HBV-Presl were detected by enzyme-linked immunosorbent assay,and HBV-DNA was quantitatively detected by PCR-fluorescence probe method. Result:No abnormalities of Pre-S1 and HBV-LP were found in groups A and B. The positive rates of HBeAg in the C, D and E groups were 0.99％,6.02％,and 77.50％, respectively; the positive rates of Pre-S1 were 29.35％,42.86％,and 90.00％, respectively; the positive rate of HBV-LP was 38.31％,55.64％, 95.00％,The positive possibility of HBV-LP,HBeAg and Pre-S1 increased with the increase of HBV-DNA content(P＜0.05). The detection rates of HBeAg,Pre-S1,and HBV-LP in the C,D,and E groups were 10.96％,40.64％, and 50.53％ respectively. The detection rate of HBV-LP was significantly higher than that of HBeAg and Pre-S1 (P＜0.05). By comparing the HBV-LP, HBeAg,and Pre-S1 positive rates of the same HBV-DNA content group by statistical t test,it can be seen that the detection rate of HBV-LP is significantly higher than the detection rate of HBeAg and Pre-S1 (P＜ 0.05). The average absorbance A values of HBV-LP in the C,D,and E groups were 2.53,5.35,and 13.93,respectively. The increase in HBV-DNA content was accompanied by an increase in HBV-LP concentrations(P＜0.05). Conclusion: HBV-LP has a more sensitive and higher detection rate than HBeAg and Pre-s1. The detection of HBV-LP was positively correlated with the detection of HBV-DNA, HBV-LP had an ideal detection rate when HB-sAg was positive and HBV-DNA was negative,which may complement the diagnosis and treatment of hepatitis B.