目的：分析自身抗体和D-二聚体在慢性乙型病毒性肝炎(慢乙肝)和乙型病毒性肝炎肝硬化（肝硬化）中的水平，探讨其在评估疾病进展、患者预后中的价值。方法：回顾性分析2020年1月至2023年1月就诊于我院的乙肝患者，筛选符合入组标准的连续病例共147例，包括慢乙肝82例（慢乙肝组）、肝硬化65例（肝硬化组）。以同期60例健康体检者为对照组，分析各组自身抗体及D-二聚体的水平。随访1年，以出现消化道出血、肝性脑病甚至死亡为预后不良，将肝硬化患者分为预后良好组和不良组，将自身抗体和D-二聚体等指标纳入二元logistic回归分析，分析肝硬化患者的预后不良的危险因素。结果：慢乙肝组及肝硬化组的自身抗体阳性率分别为25.61%、27.69% (P>0.05)，均高于对照组（8.33%）（P<0.05）。抗核抗体阳性率分别为14.63%、4.62%（P<0.05），余抗体阳性率差异无统计学意义。慢乙肝组、肝硬化组D-二聚体水平分别为0.28(0.19,0.51) mg/L、1.19(0.53,2.49) mg/L（P<0.05），其中肝硬化组高于对照组[0.27（0.20,0.32）]（P<0.05）。肝硬化预后不良组和预防良好组，自身抗体阳性率分别为47.06%、20.83%（P<0.05），D-二聚体水平分别为1.78(0.90,6.28) mg/L、1.06(0.32,2.07) mg/L(P<0.05)。回归分析表明，自身抗体阳性[OR=7.447(2.016~27.507)，P=0.003]、D-二聚体水平升高[OR=1.336(1.028~1.736)，P=0.030]均为肝硬化患者预后不良的危险因素。受试者操作特征曲线显示，自身抗体阳性预测肝硬化预后不良的灵敏度为53.6%，特异度为83.0%；当D-二聚体最佳临界值为≥0.84 mg/L时，预测肝硬化预后不良的灵敏度为88.9%，特异度为44.7%。二者联合预测的灵敏度为72.2%，特异度为85.1%。结论: 相对于健康体检者，慢乙肝和肝硬化患者的自身抗体阳性率和D-二聚体水平升高，但自身抗体阳性率与疾病进程无关，而D-二聚体水平升高与疾病进程相关。抗核抗体阳性率随疾病进展有所下降。自身抗体与D-二聚体联合检测，可用于预测肝硬化患者的预后。

Objective To detect autoantibodies and D-dimer in patients with chronic hepatitis B (CHB) or with hepatitis B cirrhosis (cirrhosis), and explore the value of detection in evaluating disease progression and prognosis of the patients. Methods A total of 147 consecutive cases meeting the enrollment criteria were collected in out hospital during January 2020 to January 2023, including 82 cases of CHB(CHB group) and 65 cases of cirrhosis(Cirrhosis group). Sixty healthy subjects were selected as the control, and autoantibody detection and D-dimer level were analyzed. In Cirrhosis group,patients died or suffered from digestive bleeding or hepatic encephalopathy were classified into poor prognosis group, and the other into good prognosis group. The autoantibody positivity and D-dimer level were included in binary logistic regression analysis to idetntify the risk factors for poor prognosis in patients with cirrhosis. Results The positive rate of autoantibody in CHB Group （25.61%）and Cirrhosis group （27.69%）were higher than that in control group（8.33%） (P<0.05).The positive rates of antinuclear antibody in CHB and Cirhosis group were 14.63% and 4.62% (P<0.05), and there was no significant difference in positive rates of other antibodies between CHB and Cirrhosis group. The D-dimer levels in CHB and Cirrhosis groups were 0.28 (0.19,0.51) mg/L and 1.19 (0.53,2.49) mg/L(P<0.05), and D-dimer level in Cirrhosis group was higher than that in control group[0.27(0.20,0.32)] (P<0.05). The positive rates of autoantibody in the poor and good prognosis groups of cirrhosis were 47.06% and 20.83%(P<0.05), and D-dimer levels were 1.78 (0.90,6.28) mg/L and 1.06 (0.32,2.07) mg/L(P<0.05). Regression analysis showed that the positive autoantibody [OR=7.447(2.016-27.507), P=0.003] and D-dimer level increase [OR=1.336(1.028-1.736), P=0.030] were risk factors for poor prognosis in patients with cirrhosis. The receiver operating characteristic curve showed that the sensitivity and specificity of positive autoantibody for predicting poor prognosis of cirrhosis were 53.6% and 83.0%, respectively. When the optimal cut-off value of D-dimer was ≥ 0.84 mg/L, the prediction sensitivity for poor prognosis in cirrhosis patients was 88.9%, and specificity was 44.7%. When combination of D-dimer level and autoantibody positivity was performed, the sensitivity and the specificity for predicting poor prognosis was 72.2%, 85.1%, respectively. Conclusions Autoantibody positive rate and D-dimer level are higher in patients with CHB or cirrhosis compared to the healthy subjects. The positive rate of autoantibody is not related to the disease course, while the increase of D-dimer is related to the disease course. The positive rate of antinuclear antibody decreased with the progression of the disease. Combined detection of autoantibody and D-dimer may be used to predict the prognosis of patients with cirrhosis.